肥胖型2型糖尿病行腹腔镜胃旁路术后胆囊结石发病的研究

Incidence of cholelithiasis after laparoscopic Roux en Y gastric bypass for the treatment of type 2 diabetes mellitus with obesity

    摘要
  • 摘要: 目的:探讨肥胖型2型糖尿病行腹腔镜胃旁路术(LRYGB)后胆囊结石的发病情况。
    方法:回顾性分析2011年3月至2013年3月上海交通大学附属第六人民医院收治的89例肥胖型2型糖尿病患者行LRYGB的临床资料。66例患者术后无新发胆囊结石或胆泥淤积，设为正常组；23例患者术后出现新发胆囊结石或胆泥淤积，设为胆囊结石组。分析患者术后6、12、24个月腰围、臀围、体质量、BMI、多余体质量减少率(EWL)、空腹血糖、餐后2 h血糖、糖化血红蛋白、稳态胰岛素评价指数(HOMAIR)、TC、TG、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、血胆汁酸。采用住院、门诊和电话方式进行随访，随访时间截至2015年4月。正态分布的计量资料以±s表示，组间比较采用t检验；重复测量数据采用重复测量的方差分析。计数资料比较采用χ2检验。
    结果:89例患者顺利完成LRYGB，均获得术后随访，中位随访时间为31个月(24～48个月)。正常组患者术后6、12、24个月EWL、糖化血红蛋白、血胆汁酸分别为113%± 43%、117%±64%、119%±84%，6.1%±0.8%、6.2%±1.1%、6.4%±1.0%，(4.6±3.8)μmol/L、(4.5± 3.6)μmol/L、(4.6±3.8)μmol/L；胆囊结石组患者分别为157%±96%、152%±102%、151%±93%，5.9%±0.8%、5.8%±0.6%、5.9%±0.8%，(23.9±9.0)μmol/L、(11.8±7.3)μmol/L、(10.5±9.6)μmol/L。两组上述指标变化趋势比较，差异均有统计学意义(F=6.896，5.226，5.351，P<0.05)。正常组和胆囊结石组患者术后6、12、24个月EWL比较，差异均有统计学意义(t=2.814，2.628，2.099，P<0.05)；术后12个月糖化血红蛋白两组比较，差异有统计学意义(t=2.018，P<0.05)；术后6、24个月血胆汁酸两组比较，差异均有统计学意义(t=-1.378，-1.990，P<0.05)。
    结论:肥胖型2型糖尿病患者行LRYGB术后存在一定的胆囊结石发病率，术后体质量下降过快可能与胆囊结石发病相关；胆囊结石患者血胆汁酸水平升高。

     

    Abstract: Objective:To investigate the incidence of cholelithiasis after laparoscopic RouxenY gastric bypass(LRYGB) for treatment of type 2 diabetes mellitus with obesity.
    Methods:The clinical data of 89 obese patients with type 2 diabetes mellitus who underwent LRYGB at the Sixth People′s Hospital Affiliated to Shanghai Jiaotong University from March 2011 to March 2013 were retrospectively analyzed. Sixtysix patients without postoperative gallstone and sludge were divided into the normal group and 23 with postoperative gallstone or sludge into the gallstone group. The waistline, hipline, body weight, body mass index(BMI), excess weight loss (EWL), fasting blood glucose, postprandial 2hour blood glucose, glycosylated hemoglobin (HbAlc), homeostasis model assessmentinsulin resistance (HOMAIR), total cholesterol (TC), triglyceride (TG), highdensity lipoprotein cholesterol (HDLc), lowdensity lipoprotein cholesterol (LDLc), serum total bile acid at postoperative month 6, 12, 24 were analyzed. The patients were followed up by inpatient, outpatient examination and telephone interview till April 2015. Measurement data with normal distribution were presented as ±s, comparison between groups and repeated measures data were analyzed using the t test and repeated measures ANOVA, respectively. Count data were analyzed by the chisquare test.
    Results:All the 89 patients underwent successful LRYGB and were followed up for 31 months (range, 24-48 months). The EWL, HbAlc and serum total bile acid at postoperative month 6, 12, 24 were 113%±43%, 117%±64%, 119%±84% and 6.1%±0.8%, 6.2%±1.1%, 6.4%± 1.0% and (4.6±3.8)μmol/L, (4.5±3.6)μmol/L, (4.6±3.8)μmol/L in the normal group and 157%±96%, 152%±102%, 151%±93% and 5.9%±0.8%, 5.8%±0.6%, 5.9%±0.8% and (23.9±9.0)μmol/L, (11.8±7.3)μmol/L, (10.5±9.6)μmol/L in the gallstone group, respectively, showing significant differences in changing trend between the 2 groups (F=6.896, 5.226, 5.351, P<0.05). There were significant differences in the EWL at postoperative month 6, 12, 24 between the 2 groups (t=2.814, 2.628, 2.099, P<0.05). There were significant differences in the HbAlc at postoperative month 12 and serum total bile acid at postoperative month 6, 24 between the 2 groups (t=2.018,-1.378,-1.990, P<0.05).
    Conclusion:There is incidence risk of cholelithiasis after LRYGB in obese patients with type 2 diabetes mellitus. The rapid decreasing of weight is associated with cholelithiasis in which patients have higher level of serum bile acid.

     

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