3D腹腔镜胃袖状切除术治疗肥胖症合并2型糖尿病的临床疗效

Clinical efficacy of the three dimensional laparoscopic sleeve gastrectomy in treatment of obesity combined with type 2 diabetes mellitus

    摘要
  • 摘要: 目的:探讨3D腹腔镜胃袖状切除术治疗肥胖症合并2型糖尿病的临床疗效。
    方法:采用回顾性横断面研究方法。收集2013年1月至2016年4月青海红十字医院收治的28例肥胖症合并2型糖尿病患者的临床资料。患者行3D腹腔镜胃袖状切除术。观察指标：(1)手术及术后恢复情况。(2)随访及代谢指标变化情况。采用门诊和电话方式进行随访，了解患者出院后并发症发生情况及降糖药物或胰岛素应用情况；检测术后1、3、6、12个月体质量、BMI、Hb、Alb、空腹血清C肽、空腹血糖、餐后2 h血糖、糖化血红蛋白水平。随访时间截至2017年2月。正态分布的计量资料以±s表示，重复测量数据采用重复测量方差分析。计数资料以百分比表示。
    结果:(1)手术及术后恢复情况：28例患者均顺利完成3D腹腔镜胃袖状切除术，无中转开腹患者。28例患者手术时间为(133±20)min，术中出血量为(45±22)mL，术后胃肠功能恢复时间为(2.5±1.2)d，术后腹腔引流管拔除时间为(3.4±0.9)d。28例患者无术后并发症发生和围术期死亡，术后住院时间为(7.1±1.5)d。(2)随访及代谢指标变化情况：28例患者均获得术后随访，随访时间为6～12个月，中位随访时间为8个月。随访期间，患者无死亡及严重并发症发生。28例患者术前、术后1、3、6、12个月体质量由(113±26)kg下降为(78±14)kg，BMI由(44±6)kg/m2下降为(35±5)kg/m2，Hb由(157±19)g/L下降为(140±13)g/L，Alb由(43±5)g/L下降为(40±4)g/L，空腹血清C肽由(2.50±0.37)μg/L下降为(1.20±0.33)μg/L，空腹血糖由(10.5±2.0)mmol/L下降为(5.6±0.5)mmol/L，餐后2 h血糖由(16.3±3.1)mmol/L下降为(7.9±0.9)mmol/L，糖化血红蛋白由9.2%±0.9%下降为6.8%±0.6%，上述指标术前与术后比较，差异均有统计学意义(F=396.47，328.20，111.10，21.28，161.06，127.80，243.40，234.64，P<0.05)，均呈下降趋势。28例患者术后12个月2型糖尿病临床完全缓解25例，临床部分缓解3例，有效率为100.0%(28/28)；多余体质量减少率为63%±16%。
    结论:3D腹腔镜胃袖状切除术治疗肥胖症合并2型糖尿病安全有效，近期疗效较好。

     

    Abstract: Objective:To explore the clinical efficacy of three dimensional (3D) laparoscopic sleeve gastrectomy (LSG) in the treatment of obesity combined with type 2 diabetes mellitus.
    Methods:The retrospective crosssectional study was conducted. The clinical data of 28 patients with obesity combined with type 2 diabetes mellitus who were admitted to the Qinghai Red Cross Hospital between January 2013 and April 2016 were collected. All the patients underwent 3D LSG. Observation indicators: (1) surgical and postoperative recovery situations; (2) followup and metabolic indexes changes. Followup using outpatient examination and telephone interview was performed to detect complications of patients after discharge and usages of antidiabetic drugs or insulin up to February 2017. Body mass, body mass index (BMI), hemoglobin (Hb), albumin (Alb), fasting serum Cpeptide, fasting blood sugar, 2hours postprandial blood glucose (2HPBG) and glycosylated hemoglobin (GHb) were detected at month 1, 3, 6 and 12 postoperatively. Measurement data with normal distribution were represented as ±s. Repeated measurement data were analyzed by the repeated measures ANOVA. Count data were evaluated by the proportion.
    Results:(1) Surgical and postoperative recovery situations: 28 patients underwent successful 3D LSG, without conversion to open surgery. Operation time, volume of intraoperative blood loss, time of postoperative gastrointestinal function recovery and time of postoperative drainage tube removal were (133±20)minutes, (45±22)mL, (2.5±1.2)days and (3.4±0.9)days, respectively. There were no postoperative complications and perioperative death. Duration of hospital stay was (7.1±1.5)days. (2) Followup and metabolic indexes changes: 28 patients were followed up for 6-12 months, with a median time of 8 months. During the followup, there was no death or severe complications. Body mass, BMI, Hb, Alb, fasting serum Cpeptide, fasting blood sugar, 2HPBG and GHb from preoperation to month 1, 3, 6 and 12 postoperatively were decreased from (113±26)kg to (78±14)kg, from (44±6)kg/m2 to (35±5)kg/m2, from (157±19)g/L to (140±13)g/L, from (43±5)g/L to (40±4)g/L, from (2.50±0.37)μg/L to (1.20±0.33)μg/L, from (10.5±2.0)mmol/L to (5.6±0.5)mmol/L, from (16.3±3.1)mmol/L to (7.9±0.9)mmol/L, from 9.2%±0.9% to 6.8%±0.6% with statistically significant differences between preoperative and postoperative indicators (F=396.47, 328.20, 111.10, 21.28, 161.06, 127.80, 243.40, 234.64, P<0.05), and showing a downward trend. Of 28 patients, 25 had complete remission of type 2 diabetes mellitus at 12 months postoperatively and 3 had partial remission, with an effective rate of 100.0%(28/28). The excess weight loss was 63%±16%.
    Conclusion: 3D LSG is safe and effective in the treatment of obesity combined with type 2 diabetes mellitus, with a good shortterm outcome.

     

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