中国实用外科杂志

中国实用外科杂志 ›› 2023, Vol. 43 ›› Issue (05): 557-561.DOI: 10.19538/j.cjps.issn1005-2208.2023.05.15

• 论著 • 上一篇    下一篇

胃袖状切除术联合近端空肠旁路术与Roux-en-Y胃旁路术治疗2型糖尿病对照研究#br#

梁    辉，李    聪，林士波，沈佳佳，管    蔚   

  1. 南京医科大学第一附属医院普外科，江苏南京210029
  • 出版日期:2023-05-01 发布日期:2023-05-29

  • Online:2023-05-01 Published:2023-05-29

摘要： 目的    比较胃袖状切除术联合近端空肠旁路术（SG-PJB）与Roux-en-Y胃旁路术（RYGB）治疗2型糖尿病的效果和安全性。方法    回顾性分析2019年1月至2021年12月在南京医科大学第一附属医院减重代谢中心行手术治疗的2型糖尿病病人资料，其中行SG-PJB 34例（SG-PJB组），行RYGB 36例（RYGB组），比较分析病人术前及术后1年的体重、血糖、血压以及糖化血红蛋白、血脂等指标。结果    SG-PJB组与RYGB组糖尿病病程分别为（1.1±0.6）年和（5.6±3.5）年，手术时间分别为（122.1±29.6）min和（128.6±28.6）min，两组比较差异有统计学意义（P＜0.05）。SG-PJB组与RYGB组比较，术后1年总体重下降百分比（%TWL）［（35.6±6.8）% vs. （35.2±7.6）% ，t=1.043，P=0.3025），多余体重减少百分比（%EWL）［（84.6±15.6）%vs.（83.9±23.5）%，t=1.526，P=0.1063］、糖尿病缓解率［94.1%（32/34）vs. 83.3%（30/36），χ2=2.009，P=0.1564］，差异无统计学意义。术后1年两组体重、体重指数（BMI）、糖化血红蛋白、空腹血糖、总胆固醇（TC）、甘油三酯（TG）、低密度脂蛋白（LDL）均分别较术前下降，白蛋白、高密度脂蛋白（HDL）均分别较术前上升（P均＜0.05）。上述各指标的术后结果在两组间比较显示 ，除TC和 LDL两组间差异有统计学意义（P均＜0.05）外，其余各指标两组间比较差异无统计学意义（P均＞0.05）。手术相关并发症方面两组差异无统计学意义（P均＞0.05）。SG-PJB组贫血发生率（5.9%，2/34）低于RYGB组（27.8%，10/36），差异具有统计学意义（χ2=5.902，P=0.0151）。SG-PJB组4例有明显反流性食管炎的症状（29.4%，4/34），而在RYGB组无反流性食管炎的病例，两组间差异有统计学有意义（χ2=4.492，P=0.0341）。结论    SG-PJB和RYGB治疗2型糖尿病均安全有效，两种术式术后1年糖尿病缓解率相似，SG-PJB可作为治疗2型糖尿病的术式之一，未来还需要高质量的多中心前瞻性研究。

关键词: 减重与代谢手术, 2型糖尿病, 胃袖状切除术, 近端小肠旁路术, 缓解率, 并发症

Abstract: A comparative study between sleeve gastrectomy with proximal jejunal bypass and Roux-en-Y gastric bypass in alleviating type 2 diabetes mellitus        LIANG Hui, LI Cong, LIN Shi-bo, et al. Department of General Surgery, the First Affiliated Hospital of Nanjing Medical University, Nanjing210029, China
Corresponding author:LIANG Hui, E-mail:drhuiliang@126.com
Abstract Objective To compare the efficacy and safety between sleeve gastrectomy with proximal jejunal bypass(SG-PJB)  with Roux-en-Y gastric bypass (RYGB) in alleviating type 2 diabetes mellitus. Methods The data of patients with diabetes who underwent surgical treatment at the Bariatric and Metabolic Center of the First Affiliated Hospital of Nanjing Medical University from January 2019 to December 2021 were retrospectively analyzed, including 34 cases of SG-PJB (SG-PJB group) and 36 cases of RYGB(RYGB group). Preoperative and postoperative 1-year weight, blood glucose, blood pressure and other basic indicators, as well as HbA1c, blood lipid of patients were compared. Results The duration of diabetes in SG-PJB group and RYGB group was (1.1±0.6) and (5.6±3.5) years, and the operation time was (122.1±29.6) min and (128.6±28.6) min, respectively. There was statistical difference between the two groups (P < 0.05). There was no statistical difference in the percentage of total weight loss (%TWL) ［(35.6±6.8) % vs. (35.2±7.6) %, t=1.043, P=0.3025］, and percentage of excess weight loss (%EWL) ［(84.6±15.6) % vs. (83.9±23.5) %, t=1.526, P=0.1063］, and remission rate of diabetes ［94.1% (32/34) vs. 83.3% (30/36), χ2=2.009, P=0.1564］ between the two groups. One year after surgery, body weight, body mass index (BMI), glycocated hemoglobin, fasting blood glucose, total cholesterol (TC), triglyceride (TG) and low density lipoprotein (LDL) in both groups were decreased, while albumin and high density lipoprotein (HDL) were increased, respectively, compared with those before surgery (all P< 0.05). The postoperative results of the above indexes were compared between the two groups, TC and LDL, which had statistical difference between the two groups (all P< 0.05), the other indexes had no statistical  difference between the two groups (all P>0.05). There was no significant difference in surgery-related complications between the two groups (all P>0.05). The incidence of anemia in SG-PJB group (5.9%, 2/34) was lower than that in RYGB group (27.8%, 10/36), and the difference was statistically significant (χ2=5.902, P=0.0151). Four patients in SG-PJB group had obvious symptoms of reflux esophagitis (29.4%,4/34), while no patients in RYGB group had reflux esophagitis, and the difference between the two groups was statistically significant (χ2=4.492, P=0.0341). Conclusion    SG-PJB and RYGB are safe and effective in the treatment of type 2 diabetes, and the 1-year remission rates of diabetes are similar between the two types of surgery. SG-PJB can be used as one of the surgical treatments for type 2 diabetes, and high-quality multicenter prospective studies are needed in the future.

Key words: bariatric and metabolic surgery, type 2 diabetes mellitus, sleeve gastrectomy, proximal jejunal bypass, remission rate, complication