南方医科大学学报

南方医科大学学报 ›› 2020, Vol. 40 ›› Issue (07): 1044-1048.doi: 10.12122/j.issn.1673-4254.2020.07.20

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腹腔镜胃旁路术治疗非肥胖2型糖尿病患者的疗效分析

吴壮炜，吴良平，戴晓江，赵为国，余 翔，宋志高，杨宝琳，黄宗海   

  • 出版日期:2020-07-20 发布日期:2020-07-20
  • 基金资助:

Therapeutic effect of laparoscopic Roux-en-Y gastric bypass in non-obese patients with type 2 diabetes

  

  • Online:2020-07-20 Published:2020-07-20

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摘要： 目的 探讨腹腔镜下胃旁路手术治疗非肥胖2型糖尿病的有效性。方法 回顾性分析2012年3月~2018年6月在广州军区广州总医院甲乳糖尿病外科及广州中医药大学金沙洲医院接受腹腔镜胃旁路术手术，且术后随访满1、2、3年的BMI<27.5 kg/ m（2 低BMI组，n=39）和BMI≥27.5 kg/m（2 高BMI组，n=35）的2型糖尿病患者的物理指标、糖代谢相关指标及胰岛功能相关代谢指标。结果 74例患者均成功实施腹腔镜下胃旁路手术，无中转开腹。在低BMI组中，术后1年空腹血糖、HbA1c、餐后2 h血糖、空腹胰岛素、HOMA-IR、空腹C肽、BMI、体质量、腰围较术前均有明显改善（P<0.05）；术后2年，空腹血糖、HbA1c、餐后2 h血糖、 HOMA-IR、BMI、体质量、腰围较术前均有明显改善（P<0.05）；术后3年，空腹血糖、HOMA-IR、空腹C肽、体质量、腰围较术前均有明显改善（P<0.05）；无严重并发症。低BMI组和高BMI组术后糖代谢和胰岛功能等指标未见明显差异（P>0.05）。结论 腹腔镜下胃旁路手术对我国非肥胖2型糖尿病患者是一种长期有效的降糖方法，主要降低患者腰围而不会有明显的体质量下降。更加长期的疗效还需大样本、更长时间的随访。

关键词: 腹腔镜胃旁路术, 非肥胖, 2型糖尿病

Abstract: Objective To evaluate the effectiveness of laparoscopic Roux-en-Y gastric bypass (LRYGB) surgery for treatment of type 2 diabetes (T2D) in patients with a body mass index (BMI)<27.5 kg/m2. Methods We retrospectively analyzed the data of patients who underwent LRYGB surgery from March, 2012 to June, 2018 in the General Hospital of Guangzhou Military Command and Jinshazhou Hospital of Guangzhou University of Chinese Medicine. The changes in the parameters of glucose metabolism and physical indicators of the patients in the first, second and third years after the surgery were analyzed in patients in low BMI group and high BMI group. Results All the 74 patients underwent LRYGB successfully without conversion to open surgery. One year after the surgery, fasting blood glucose (FBG), HbA1c, postprandial blood glucose, fasting insulin, HOMA-IR, fasting C-peptide, BMI, body weight and waistline were significantly improved compared with their preoperative values in low BMI group (P<0.05). At 2 years after the operation, FBG, HbA1c, postprandial blood glucose, HOMA-IR, BMI, body weight and waistline were significantly improved compared with the preoperative values in low BMI group (P<0.05). In the third year, FBG, HOMA-IR, fasting C-peptide, body weight and waistline were significantly improved compared with the preoperative values in low BMI group (P<0.05). There was no significant difference in the parameters of glucose metabolism and islet function between low BMI group and high BMI group at different stages. No serious complications occurred in these patients after the surgery. Conclusion LRYGB is effective for treatment of T2D in Chinese patients with a BMI<27.5. After the surgery, the patient show reduced waistline without significant weight loss. The long-term results of the surgery still require further investigations with a larger samples and longer follow-up.

Key words: laparoscopic Roux-en-Y gastric bypass, non-obese, type 2 diabetes