腹腔镜胃袖状切除术联合十二指肠空肠吻合术与腹腔镜Roux-en-Y胃旁路术治疗非肥胖型2型糖尿病的疗效比较

Comparison of the efficacies of laparoscopic sleeve gastrectomy with duodenojejunal bypass and laparoscopic Roux en Y gastric bypass in the treatment of patients with non obese type 2 diabetes mellitus

    摘要
  • 摘要: 目的：比较腹腔镜胃袖状切除术+十二指肠空肠吻合术和腹腔镜Roux-en-Y胃旁路术治疗非肥胖型(BMI<30 kg/m 2)2型糖尿病患者的近期疗效。
    方法：回顾性分析2012年1月至2013年6月南京医科大学第一附属医院接受手术治疗的BMI<30 kg/m 2的42例2型糖尿病患者的临床资料。15例患者行腹腔镜胃袖状切除术+十二指肠空肠吻合术(Sleeve+DJB组)，27例行腹腔镜Roux-en-Y胃旁路术(RYGB组)。所有患者随访时间>6个月。比较两组患者术后BMI下降情况，糖尿病完全缓解率，空腹血糖和糖化血红蛋白下降情况，以及术后营养和并发症发生情况。计量资料采用 t检验和重复测量的方差分析，计数资料用χ 2 检验。结果：Sleeve +DJB组和RYGB组的手术时间分别为(137±61)min和(89±43)min，两组比较，差异有统计学意义( t=6.158，P <0.05)。无患者死亡，无大出血、肠梗阻、吻合口狭窄等严重并发症发生。Sleeve+DJB组1例患者术后发生胆汁漏，经保守治疗5 d后痊愈出院。Sleeve+DJB组患者术前和术后1、3、6个月的空腹血糖水平分别为(8.9±0.7)mmol/L、(5.8±1.3)mmol/L、(5.6±1.8)mmol/L、(5.7±0.3)mmol/L，RYGB组患者分别为(9.9±1.2)mmol/L、(6.9±0.8)mmol/L、(6.6±2.2)mmol/L、(5.6±0.8)mmol/L，两组比较，差异无统计学意义( F=1.670，2.932，0.444，0.158，P>0.05)。Sleeve+DJB组患者术前和术后1、3、6个月的糖化血红蛋白值分别为7.4%±1.4%、6.5%±0.6%、5.7%±0.5%、5.9%±0.6%，RYGB组患者分别为7.7%±2.0%、6.8%±1.3%、5.7%±0.8%、5.6%±1.1%，两组比较，差异无统计学意义(F=0.055，0.125，0.005，0.286，P>0.05)。Sleeve+DJB组和RYGB组患者术后6个月糖尿病完全缓解率分别为14/15和74.1%(20/27)，两组比较，差异无统计学意义(χ2=2.320，P>0.05)。Sleeve+DJB组和RYGB组患者BMI下降比例分别为18.2%±9.5%和21.2%±4.9%，两组比较，差异无统计学意义(t=0.982，P>0.05)。Sleeve+DJB组和RYGB组患者术后出现贫血、维生素缺乏、腹泻分别为0、0、2例和3、2、6例，两组比较，差异无统计学意义(χ2=1.795，1.167，0.908，P>0.05)。所有患者术后6个月BMI>19 kg/m2。
    结论：胃袖状切除术+十二指肠空肠吻合术和Roux-en-Y胃旁路术对于非肥胖型2型糖尿病患者的治疗效果和术后相关并发症发生率相当。胃袖状切除术+十二指肠空肠吻合术对患者营养状况的干扰略低于Roux-en-Y胃旁路术。

     

    Abstract: Objective：To investigate the efficacies of laparoscopic sleeve gastrectomy+duodenojejunal bypass (DJB) and laparoscopic gastric bypass in the treatment of patients with non obese type 2 diabetes mellitus (T2DM).
    Methods：The clinical data of 42 patients with type 2 diabetes mellitus and body mass index (BMI)<30 kg/m 2 received surgical treatment at the First Affiliated Hospital of Nanjing Medical University from January 2012 to June 2013 were retrospectively analyzed. Fifteen patients received laparoscopic sleeve gastrectomy+ DJB (Sleeve+DJB group), and 27 received Roux en Y gastric bypass (RYGB group). The follow up time for all the patients was more than 6 months. The decrease of BMI, complete remission of T2DM, decrease of fasting glycemia and glycosylated hemoglobin (HbAlc), postoperative nutritional condition and the incidence of complications of the 2 groups were compared. The measurement data were analyzed using the t test and the repeated measurement chi square test.
    Results：The operation time of the Sleeve+DJB group and the RYGB group were (137±61)minutes and (89±43)minutes, with significant difference between the 2 groups ( t=6.158, P <0.05). No mortality and hemorrhage, bowel obstruction and anastomotic stenosis were detected. One patient was complicated with bile leakage in the Sleeve+DJB group, and was cured by conservative treatment 5 days later. The levels of fasting glucose before operation and at postoperative month 1, 3, 6 were (8.9±0.7)mmol/L, (5.8±1.3)mmol/L, (5.6± 1.8) mmol/L and (5.7±0.3)mmol/L in the Sleeve+DJB group, and (9.9±1.2)mmol/L, (6.9±0.8)mmol/L, (6.6±2.2)mmol/L and (5.6±0.8)mmol/L, with no significant difference between the 2 groups ( F=1.670, 2.932, 0.444, 0.158, P >0.05). The levels of HbAlc before operation and at postoperative months 1, 3, 6 were 7.4% = 1.795, 1.167, 0.908, P >0.05). The BMIs of all the patients were above 19 kg/m 2.
    Conclusion：The effects and incidence of postoperative complications of Sleeve+DJB for the treatment of T2DM are comparable to those of RYGB. Sleeve+DJB has less interference on the nutritional condition of patients compared with RYGB.

     

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