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腹腔镜Roux-en-Y胃旁路术治疗2型糖尿病27例报告
引用本文:张海涛,梁怀祝,张利,赵国华,张向文.腹腔镜Roux-en-Y胃旁路术治疗2型糖尿病27例报告[J].中国微创外科杂志,2012,12(10):898-900,903.
作者姓名:张海涛  梁怀祝  张利  赵国华  张向文
作者单位:辽宁省大连市中心医院普外二科,大连,116033
摘    要:目的探讨腹腔镜下Roux-en-Y胃旁路术(laparoscopic Roux-en-Y gastric bypass,LRYGB)治疗2型糖尿病的临床效果。方法 2008年6月~2010年10月行腹腔镜Roux-en-Y胃旁路术27例。沿His角离断胃,保留胃囊20~30 ml,用带有刻度的分离钳保留胆胰支为60~100 cm,食物支为80~150 cm。结果 27例手术成功,无中转开腹。术后1年患者体重指数(body mass index,BMI)26.14±2.01,显著低于术前32.19±3.89(t=11.713,P=0.000);空腹血糖(6.09±1.44)mmol/L,显著低于术前(10.37±2.21)mmol/L(t=12.529,P=0.000);餐后2 h血糖(8.28±1.97)mmol/L,显著低于术前(15.89±1.37)mmol/L(t=16.205,P=0.000);糖化血红蛋白(5.95±1.44)%,显著低于术前(9.48±2.07)%(t=8.900,P=0.000);空腹C肽(1.89±0.27)ng/ml,显著低于术前(2.31±0.40)ng/ml(t=7.927,P=0.000)。1年后2型糖尿病临床治愈率81.5%(22/27),临床有效率14.8%(4/27),临床无效率3.7%(1/27)。结论 LRYGB对肥胖合并2型糖尿病患者是一种安全、有效的治疗方法。

关 键 词:2型糖尿病  Roux-en-Y胃旁路术  腹腔镜

Laparoscopic Roux-en-Y Gastric Bypass for Type 2 Diabetes Mellitus:Report of 27 Cases
Institution:Zhang Haitao,Liang Huaizhu,Zhang Li,et al.Department 2 of General Surgery,Central Hospital of Dalian,Dalian 116033,China
Abstract:Objective To investigate the efficacy of laparoscopic Roux-en-Y gastric bypass(LRYGB) for the treatment of type 2 diabetes mellitus(DM).Methods Between June 2008 and October 2010,totally 27 patients with type 2 DM underwent LRYGB in our hospital.During the operation,we dissected the stomach from the His angle while a gastric capsule of 20-30 ml was kept,and then with calibrated dissecting forceps,a 60-to 100-cm biliopancreatic limb and 80-to 150-cm alimentary limb were reserved.Results The procedure was completed in all the patients without conversion to open surgery.Re-examination at one year after the operation showed that the BMI and levels of fasting plasma glucose,2-hour postprandial plasma glucose,hemoglobin A1c,and C-peptide were significantly lower than the preoperative values 32.19±3.89 vs.26.14±2.01(t=11.713,P=0.000),(10.37±2.21) mmol/L vs.(6.09±1.44) mmol/L(t=12.529,P=0.000),(15.89±1.37) mmol/L vs.(8.28±1.97) mmol/L(t=16.205,P=0.000),(9.48±2.07)% vs.(5.95±1.44)%(t=8.900,P=0.000),and(2.31±0.40) ng/ml vs.(1.89±0.27) ng/ml(t=7.927,P=0.000),respectively].The rates of clinical cure,effective and ineffective at one year were 81.5%(22/27),14.8%(4/27),and 3.7%(1/27),respectively.Conclusion LRYGB is safe and effective for type 2 DM.
Keywords:Type 2 diabetes mellitus  Roux-en-Y surgery  Laparoscopy
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