中国实用外科杂志

中国实用外科杂志 ›› 2025, Vol. 45 ›› Issue (07): 826-831.DOI: 10.19538/j.cjps.issn1005-2208.2025.07.18

• 论著 • 上一篇    下一篇

单吻合口胃旁路术治疗2型糖尿病38例疗效分析

边识博，张翊乔，李梦伊，田沛荣，张    萌，刘    佳，刘京丽，张    鹏，刘    洋，张忠涛   

  1. 首都医科大学附属北京友谊医院普通外科中心普外六科（减重与代谢外科），北京 100050 
  • 出版日期:2025-07-01 发布日期:2025-07-27

  • Online:2025-07-01 Published:2025-07-27

摘要： 目的    分析单吻合口胃旁路术（OAGB）治疗2型糖尿病的临床疗效。方法    回顾性分析2023年1—8月首都医科大学附属北京友谊医院收治的行OAGB治疗的38例2型糖尿病病人的临床资料，均完成1年随访。比较手术前后体重、2型糖尿病病情、代谢相关性指标及胃镜检查结果的变化，并采用Logistic回归分析2型糖尿病完全缓解的影响因素。结果    共纳入38例病人，术后1年总体重减少百分比（%TWL）为（28.6±7.1）%，多余体重减少百分比（%EWL）为（124.6±57.9）%，BMI由35.1±6.1下降至25.0±4.1，糖化血红蛋白（HbA1c %）由（9.1±1.5）%下降至（5.6±1.0）%，差异均有统计学意义（P<0.001）。总胆固醇、甘油三酯、低密度脂蛋白和谷氨酰转肽酶较术前均明显降低（P均<0.001）。糖尿病完全缓解率为65.8%（25/38），与ABCD评分呈线性相关（P=0.015）；Logistic回归分析结果显示，病程（OR=0.829，P=0.016）和%TWL（OR=1.137，P=0.039）是完全缓解的影响因素。术后贫血、低蛋白血症及胆汁反流的发生率分别为18.4%、13.2%和31.3%，明显高于术前水平（P<0.05）。结论  OAGB是一种有效、安全的治疗2型糖尿病的手术方式，但仍需重点关注病人术后贫血、营养不良及胆汁反流的发生情况。

关键词: 单吻合口胃旁路术, 2型糖尿病, 临床疗效

Abstract: To evaluate the clinical effect of one anastomosis gastric bypass (OAGB) for the treatment of type 2 diabetes mellitus (T2DM). Methods  A retrospective analysis was performed on data from 38 T2DM patients who underwent OAGB between January and August 2023 with a 1-year follow-up at Beijing Friendship Hospital. Changes in body weight, glycemic control, metabolism related indicators and gastroscopy findings before and after surgery were compared. Logistic regression was used to analyze the factors influencing complete T2DM remission. Results    A total of 38 patients were included. The percentage of total weight loss (%TWL) and percent of excess weight loss (%EWL) of the patients at 1 year after surgery were (28.6±7.1)% and (124.6±57.9)%, respectively. The mean body mass index (BMI) decreased from 35.1±6.1 to 25.0±4.1 and mean glycated hemoglobin A1c (HbA1c%) decreased from (9.1±1.5)% to (5.6±1.0)%. All the above differences were statistically significant (P<0.001). The level of total cholesterol, triglycerides, low-density lipoprotein and γ-glutamyl transferase was reduced significantly after surgery than those before surgery (all P<0.001). The complete T2DM remission rate was 65.8% (25/38) and was linearly related to the ABCD score (P=0.015). Duration (OR=0.829, P=0.016) and %TWL (OR=1.137, P=0.039) were independent factors influencing complete remission. Postoperative rates of anemia, hypoalbuminemia and bile reflux were 18.4%, 13.2% and 31.3%, respectively, significantly higher than preoperative rates (all P<0.001). Conclusion    OAGB is an effective and safe treatment for T2DM. However, attention should be given to postoperative anemia, hypoalbuminemia and bile reflux.

Key words: one anastomosis gastric bypass, type 2 diabetes mellitus, clinical effect