中国实用外科杂志

中国实用外科杂志

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腹腔镜袖状胃切除术治疗肥胖症合并2型糖尿病19例短期疗效分析

卓光鑽，印    慨，常绪生，郭    翔，王    鑫，郑成竹   

  1. 第二军医大学附属长海医院微创外科，上海200433
  • 发布日期:2012-08-29

  • Published:2012-08-29

摘要：

目的    探讨行腹腔镜袖状胃切除术治疗合并2型糖尿病（type 2 diabetes mellitus，T2DM）肥胖症病人的效果。方法    回顾性分析第二军医大学附属长海医院微创外科2010年7月至2011年6月行腹腔镜袖状胃切除术治疗合并T2DM的肥胖症19例病人的术前资料和术后6个月的随访资料。结果    均在腹腔镜下完成手术。术后均无严重并发症发生。在术后6个月的随访过程中，病人体重、腰围、体重指数均呈下降趋势，与术前相比，术后1周开始差异即有统计学意义（P＜0.01）。病人术后1周、1个月、3个月、6个月额外体重减轻百分率分别为（11.68±4.07）%、（32.33±9.12）%、（55.83±14.11）%、（74.55±20.39）%。术后6个月T2DM临床完全缓解15例（78.9%），临床部分缓解4例（21.1%）。所有病人术后糖化血红蛋白、空腹血糖、胰岛素抵抗指数均呈下降趋势，从术后1个月开始，糖化血红蛋白与术前相比差异有统计学意义（P＜0.01），术后3个月复查15例(78.9%)已恢复正常水平；空腹血糖和胰岛素抵抗指数自术后1周开始与术前相比差异即有统计学意义（P＜0.01）。病人术后血脂代谢及肥胖相关合并症如高血压病、脂肪肝、关节退行性变、睡眠呼吸暂停综合征等亦有不同程度的改善。结论    腹腔镜袖状胃切除术是一种安全、有效的治疗肥胖症合并T2DM的手术方式。

关键词: 腹腔镜, 袖状胃切除术, 肥胖症, 2型糖尿病

Abstract:

Short-term effect of laparoscopic sleeve gastrectomy for 19 obesity patients with type 2 diabetes mellitus                     ZHUO Guang-zuan, YIN Kai, CHANG Xu-sheng, et al. Department of Minimally Invasive Surgery，Changhai Hospital，the Second Military Medical University，Shanghai 200433，China
Corresponding author: ZHENG Cheng-zhu, E-mail：fredzhengzz@hotmail.com
Abstract    Objective    To evaluate the short-term effect of laparoscopic sleeve gastrectomy(LSG) on obesity patients with type 2 diabetes mellitus(T2DM)．Methods    19 obesity patients with T2DM underwent LSG surgery from department of minimally invasive surgery of Changhai hospital during July 2010 to June 2011 were included, their clinical data before and after surgery were analyzed retrospectively. Result    All the performations were completed under laparoscopic. There were no conversion or operative complications. No serious post-procedure complications. During 6 months of follow-up，all the patients’ weight, waist circumference and body mass index(BMI) was decreased, compared with those before operation (P＜0.01). The percentage of excess weight loss(EWL%) at 1 week, 1 month, 3 months and 6 months after procedure was (11.68±4.07)%, (32.33±9.12)%, (55.83±14.11)%, (74.55±20.39)% respectively. 6 months after procedure, 15 （78.9%）T2DM cases got complete remission, the other 4 (21.1%）cases got partial remission. The level of hemoglobin A1c(HbA1c), fasting plasma glucose(FPG), homeostasis model assessment of insulin resistance(HOMA-IR) was decreased after procedure, especially the level of HbA1c was significantly decreased (P＜0.01) since 1 month after procedure, and 3 months later, the HbA1c level of 15(78.9%) patients had come back to the normal range. Especially encouraging was that the level of FPG and HOMA-IR had a significant decrease just since 1 week after procedure (P＜0.01). The abnormal metabolism and obesity-related complications, such as hypertension, fatty liver, osteoarticular degeneration, obstructive sleep apnea syndrome had been symptomatically improved in some degree respectively. Conclusion    LSG may result in satisfactory weight loss and clinical remission of T2DM with few complications. A longer follow-up period is needed.

Key words: laparoscopic, sleeve gastrectomy, obesity, type 2 diabetes mellitus