腹腔镜胃袖状切除联合十二指肠空肠转流术治疗2型糖尿病

Laparoscopic sleeve gastrectomy with duodenal jejunal bypass for the treatment of type 2 diabetes mellitus

    摘要
  • 摘要: 目的:探讨腹腔镜胃袖状切除联合十二指肠空肠转流术(LSG+DJB)治疗2型糖尿病的临床疗效。
    方法:回顾性分析2013年3月至2014年2月第四军医大学西京医院收治的17例行LSG+DJB治疗2型糖尿病患者的临床资料。患者术前空腹血糖为(9.2±0.6)mmol/L，餐后2 h血糖为(14.4± 2.2)mmol/L，糖化血红蛋白为8.3%±1.2%，BMI为(29.4±2.2)kg/m2。患者行LSG+DJB治疗。术后采用门诊随访，随访时间截至2015年3月。比较患者术前与术后12个月的空腹血糖、餐后2 h血糖、糖化血红蛋白和BMI。正态分布的计量资料以±s表示，采用t检验。
    结果:17例患者均顺利完成LSG+DJB，无中转开腹。手术时间为(141±53)min，术中平均出血量为40 mL，术后平均胃肠功能恢复时间为2.5 d。3例患者术后发生并发症：1例术后第5天出现吻合口漏，再次手术改为胃旁路术；1例术后第10天出现消化道梗阻，再次手术后解除梗阻；1例术后2周出现左膈下脓肿，袖状胃上部发生胃液漏，经对症治疗后痊愈。术后平均住院时间为5.2 d。17例患者均获得术后随访，中位随访时间为16个月(13～24个月)。术后12个月患者空腹血糖为(5.5±0.7)mmol/L，餐后2 h血糖为(8.8±1.7)mmol/L，糖化血红蛋白为 5.1%±0.7%，BMI为(24.7±2.3)kg/m2，与术前比较，差异均有统计学意义(t=19.96,10.52,12.06, 31.99,P<0.05)。随访期间患者无吻合口溃疡、狭窄、倾倒综合征、严重营养不良等并发症发生。
    结论:LSG+DJB治疗2型糖尿病近期降糖效果好，安全可靠。

     

    Abstract: Objective:To investigate the clinical effects of laparoscopic sleeve gastrectomy with duodenaljejunal bypass (LSG+DJB) for the treatment of type 2 diabetes mellitus.
    Methods:The clinical data of 17 patients with type 2 diabetes mellitus who underwent LSG+DJB at the Xijing Hospital of the Fourth Military Medical University from March 2013 to February 2014 were retrospectively analyzed. The fasting blood glucose, postprandial 2hour blood glucose, glycosylated hemoglobin (HbA1c) and body mass index (BMI) in 17 patients before operation were (9.2±0.6)mmol/L, (14.4±2.2)mmol/L, 8.3%±1.2% and (29.4±2.2)kg/m2, respectively. All the patients received LSG+DJB and were followed up by outpatient examination up to March 2015. The pre and postoperative 12 month fasting blood glucose, postprandial 2hour blood glucose, HbA1c and BMI in 17 patients were compared. Measurement data with normal distribution were presented as ±s and analyzed by the t test.
    Results:All the 17 patients received successful laparoscopic LSG+DJB without conversion to open surgery. The operation time, volume of intraoperative blood loss and recovery time of postoperative gastrointestinal function were (141±53)minutes, 40 mL and 2.5 days. Of 3 patients with postoperative complications, 1 patient with anastomotic leakage at postoperative day 5 received reoperation by laparoscopic RouxenY gastric bypass, 1 patient with digestive tract obstruction at postoperative day 10 released obstruction by reoperation and 1 patient with left subphrenic abscess and leakage at the upper of the stomach at postoperative week 2 was cured by the sympto matic treatment. The duration of hospital stay was 5.2 days. All the patients were followed up for a median time of 16 months (range, 13-24 months). The postoperative 12month fasting blood glucose, postprandial 2hour blood glucose, HbA1c and BMI in 17 patients were (5.5±0.7)mmol/L, (8.8±1.7)mmol/L, 5.1%±0.7% and (24.7±2.3)kg/m2, which were significantly different from preoperative indicators (t=19.96, 10.52, 12.06, 31.99, P<0.05). During the followup, no anastomotic ulcer and stenosis, dumping syndrome and severe malnutrition were occurred.
    Conclusion:LSG+DJB is safe and feasible for the treatment of type 2 diabetes mellitus, with a good shortterm hypoglycemic effect.

     

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