迷走神经切断协同改良胃旁路术治疗正常体重糖尿病研究应用

目的探讨切断迷走神经胃支协同改良胃旁路(GBP)手术对正常体重2型糖尿病患者保持体重、消除胰岛素抵抗的临床效果。方法回顾分析22例体重正常的2型糖尿病,行高选迷走神经胃支切断(保留迷走神经的肝支、腹腔支和"罪恶神经"支)、改良胃旁路手术,观察术后1～3个月的体重指数(BMI)、胰岛素释放试验(Ins)、口服糖耐量试验(OGTT)、空腹血糖(FPG)、空腹胰岛素(Fins)、胰岛素抵抗指数(HOMO-IR)等指标与术前对照。结果 22例正常体重的2型糖尿病患者手术时间49～98min,平均66min。全组患者术后均恢复良好,无吻合口漏、出血、狭窄等手术并发症发生;无倾倒综合征、胃无力、腹泻、消化不良症等动力神经损伤的并发症发生。术后1个月患者Ins、OGTT、FPG、Fins、HOMO-IR等指标与术前比较,差异有统计学意义(P<0.05)。结论选择性迷走神经胃支协同改良胃旁路手术治疗正常体重的2型糖尿病,疗效确切。

Combined application of pneumogastric nerves resection and modified gastric bypass procedures in treating diabetic patients with normal weight

Objective To investigate the results of combined treatment of pneumogastric nerves resection and gastric bypass procedures(GBP) in treating patients with type 2 diabetes mellitus(DM) and normal weight.Methods Clinical data of 22 patients with type 2 DM and normal weight,who had undergone both selective pneumogastric nerves resection and GBP were analyzed retrospectively.Clinical observation included perioperative body mass index(BMI),insulin release testing(IRT),oral glucose tolerance test(OGTT),fasting plasma glucose(FPG),fasting insulin(Fins),insulin resistance index(HOMO-IR) etc.Results In 22 patients operation time ranged from 49 to 98 minutes(average 66 minutes).All the 22 patients recovered well after operation,without complications such as stoma leakage,bleeding,and stenosis.There was no occurrence of dumping syndromes,gastroplegia,diarrhea and dyspepsia,which were associated with pneumogastric nerves injury.Compared with pre-operation,there were significant differences in BMI,IRT,OGTT,FPG,Fins and HOMO-IR after operation(P<0.05).Conclusions Combined treatment of pneumogastric nerves resection and gastric bypass procedures(GBP) is safe and effective for patients with type 2 DM and normal weight.