腹腔镜胃旁路术治疗肥胖合并2型糖尿病的临床效果

目的:探讨腹腔镜Roux-en-Y胃旁路术(laparoscopic Roux-en-Y gastric bypass,LRYGB)治疗肥胖合并2型糖尿病(type 2 diabetes mellitus,T2DM)的临床效果。方法:回顾分析2009年3月至2013年5月为7例肥胖合并T2DM患者行LRYGB的临床资料,随访3年,分析手术前后糖脂代谢指标的变化。结果:7例手术均获成功,无_例中转幵腹,术前体重指数(body mass index,BMI)≥27.5 kg/m~2,与术前相比,术后3年BMI下降(26.47±1.24)vs.(29.87±2.17),P0.05],空腹血糖(5.90±0.76)vs.(8.24±2.19),P0.05]、糖化血红蛋白HbA1c(6.28±0.42)vs.(8.06±1.73),P0.05]、总胆固醇(4.27±0.22)vs.(5.10±0.49),P0.05]、三酰甘油(1.59±0.10)vs.(1.97±0.14),P0.05]、低密度脂蛋白(2.67±0.32)vs.(3.22±0.12),P0.05]、高密度脂蛋白(1.14±0.06)vs.(1.04±0.05),P0.05]较术前均有明显改善。术后患者均无严重并发症发生。结论:LRYGB治疗肥胖合并T2DM可显著降低患者的BMI,改善血糖、血脂水平,手术安全、有效,值得临床推广应用。

Clinical effect of laparoscopic Roux-en-Y gastric bypass surgery for the treatment of obesity with type 2 diabetes mellitus

Objective:To investigate the clinical effect of laparoscopic Roux-en-Y gastric bypass ( LRYGB) for the treatment of obesity with type 2 diabetes mellitus ( T2DM) patients. Methods:The clinical data of 7 patients of obesity with T2DM performed LRYGB surgery between Mar. 2009 and May 2013 in the department of general surgery of Mianyang Central Hospital were analyzed ret-rospectively. The changes of glucose and lipid metabolism indicators of 7 patients were analyzed after 3 years of follow-up. Results:All 7 cases of obesity with T2DM were successfully operated,and no case was converted to laparotomy,all the patients’ preoperative body mass index (BMI) were ≥27. 5 kg/m2. Compared with the preoperative data,postoperative patients’ BMI decreased significantly (26. 47±1. 24) vs. (29. 87±2. 17),P<0. 05],and the fasting plasma glucose (5. 90±0. 76) vs. (8. 24±2. 19),P<0. 05],the he-moglobin HbA1c (6. 28±0. 42) vs. (8. 06±1. 73),P<0. 05],the total cholesterol (4. 27±0. 22) vs. (5. 10±0. 49),P<0. 05],the triacylglycerol (1. 59±0. 10) vs. (1. 97±0. 14),P<0. 05],the low density lipoprotein (2. 67±0. 32) vs. (3. 22±0. 12),P<0. 05],the high density lipoprotein (1. 14±0. 06) vs. (1. 04±0. 05),P<0. 05] were significantly improved. There were no severe com-plications after operation. Conclusions:LRYGB for treatment of obesity with T2DM significantly reduces the patient’ s BMI,improves the patient’ s blood glucose and blood lipid levels,it is a safe and effective treatment method,worthy of clinical application.