改良腹腔镜胃旁路术治疗2型糖尿病的临床疗效

目的探讨改良腹腔镜胃旁路术治疗2型糖尿病的临床疗效。方法前瞻性分析2012年1月至10月第四军医大学西京医院收治的30例2型糖尿病患者的临床资料。依据患者住院号将30例患者分为常规手术组（15例），施行常规腹腔镜胃旁路术；改良手术组（15例），施行改良腹腔镜胃旁路术。比较两组患者手术时间、术中出血量、肛门排气时间、术后住院时间、术后严重并发症、术后3个月BMI、空腹血糖（FPG）、空腹血清胰岛素（Fins）、空腹血清C肽（FC—P）和糖化血红蛋白（HbAlc）的差异，计量资料组间比较采用t检验，计数资料比较采用Fisher确切概率法检验。结果常规手术组和改良手术组患者手术时间分别为（141±22）min和（113±26）rain，两组比较，差异有统计学意义（t=3．184，P〈0．05）。常规手术组和改良手术组患者术中出血量、肛门排气时间、术后住院时间及术后3个月BMI、FPG、Fins、FC—P和HbAlc分另1为（65±29）ml、（2．5±1．2）d、（7．5±2．1）d、（27±4）kg／m2、（6．7±1．5）mmol／L、（18±8）mU／L、（2．0±0．6）斗∥L、5．8％±1．5％和（57±25）ml、（2．1±1．0）d、（7．1±1．9）d、（28±4）kg／m。、（6．4±2．0）mmol／L、（17±6）mU／L、（1．9±0．6）¨g／L、6．1％±1．4％，两组比较，差异无统计学意义（t=0．809，0．992，0．545，0．485，0．463，0．523，0．130，0．572，P〉0．05）。常规手术组患者术前BMI、FPG、Fins、FC—P和HbAlc分别为（31±4）kg／m。、（11．3±2．3）mmol／L、（13±4）mU／L、（1．4±0．5）μg/L和8．6％±1．0％，与术后3个月相应指标比较，差异有统计学意义（t=2．304，6．615，3．109，2．920，5．997，P〈0．05）。改良手术组患者术前BMI、FPG、Fins、FC—P和HbAlc分别为（31±4）kg／ITI。、（11．9±2．4）mmol／L、（12±5）mU／L、（1．4±0．6）μg/L和8．9％±0．9％，与术后3个月相应指标比较，差异有统计学意义（t=2．165，6．711，2．616，2．478，6．571，P〈0．05）。结论改良腹腔镜胃旁路术的安全性、治疗2型糖尿病的近期疗效与常规腹腔镜胃旁路术相当，但能明显缩短手术时间。

Efficacy of modified laparoscopic gastric bypass in the treatment of type 2 diabetes mellitus

± Objective To investigate the efficacies of conventional and modified laparoscopic gastric bypass in the treatment of type 2 diabetes mellitus. Methods The clinical data of 30 patients with type 2 diabetes mellitus who were admitted to the Xijing Hospital of the Fourth Military Medical University from January 2012 to October 2012 were prospectively analyzed. All the 30 patients were randomly divided into the conventional group （ 15 patients） and the modified group （ 15 patients） according to the random number table. Patients in the 2 groups received conventional and modified laparoscopic gastric bypass, respectively. The operation time, blood loss, anal exhaust time, duration of postoperative hospital stay, incidence of severe complications, postoperative 3-month body mass index （BMI）, fasting plasma glucose （FPG）, fasting serum insulin （Fins）, fasting serum C-peptide （FC-P） and glycosylated hemoglobin （HbAlc） of the 2 groups were compared. The measurement data were analyzed using the t test, and the count data were analyzed using the Fisher exact probability. Results The operation time of the conventional group and the modified group were （141 ± 22）minutes and （113 ± 26 ）minutes, with significant difference between the 2 groups （t = 3. 184, P 〈 0.05 ）. The volume of intraoperative blood loss,anal exhaust time, duration of postoperative hospital stay, postoperative 3-month BMI, FPG, Fins, FC-P and HbAlc were （65 ＋29）ml, （2.5 ＋ 1.2）days, （7.5 ±2.1）days, （27 ±4）kg/m2, （6.7 ＋ 1.5）mmol/L, （18 ± 8 ） mU/L, （ 2.0 ± 0.6） p~g/L and 5.8% ＋ 1.5% in the eonventional group, and （ 57 -＋ 25 ） ml, （ 2.1 ＋ 1. O） days, （7.1±l.9）days, （28 ＋4）kg/mz, （6.4＋2.0）retool/L, （17 ＋6）mU/L, （1.9±0.6）p~g/L and 6.1%-＋ 1.4% in the modified group, with no significant differenee between the 2 groups （t = 0. 809, O. 992, 0. 545, O. 485, 0. 463,0. 523, O. 130, 0. 572, P 〉 0.05 ）. The levels of preoperative BMI, FPG, Fins, FC-P and HbAle of the eonventional group were （ 31 ＋ 4 ） kg/m2, （ 11.3 ＋ 2.3 ） mmol/L, （ 13 -＋ 4 ） mU/L, （ 1.4 ＋- 0.5 ） p~g/L and 8.6% -i-- 1.0%, which were significantly different from those at 3 months after operation （ t -- 2. 304, 6. 615, 3. 109, 2. 920, 5. 997, P 〈 0.05）. The levels of preoperative BMI, FPG, Fins, FC-P and HbAlc of the modified group were （31 ±4）kg/m2, （ll.9±2.4）mmol/L, （12±5）mU/L, （1.4 ±0. 6） /xg/L and 8.9%±0.9%, which were significant different from those at 3 months after operation （t =2. 165, 6. 711, 2. 616, 2. 478, 6. 571, P 〈0.05）. Conclusion The safety and short-term efficacy of modified laparoseopie gastric bypass are comparable to those of the conventional laparoseopie gastric bypass, but the operation time of the modified method is significantly shorter.