腹腔镜Roux-en-Y胃旁路术与腹腔镜袖状胃切除术减重与改善代谢紊乱的比较研究

doi:10.16139/j.1007-9610.2020.05.009

摘要/Abstract

摘要：

目的： 比较分析腹腔镜Roux-en-Y胃旁路术（laparoscopic Roux-en-Y gastric bypass,LRYGB）与腹腔镜袖状胃切除术（laparoscopic sleeve gastrectomy,LSG）治疗肥胖合并 2 型糖尿病病人的近期效果。方法： 回顾性分析2011年1月至2018年12月行LRYGB（38例）和LSG（38例）的2型糖尿病病人。根据年龄、性别、体质量指数、糖化血红蛋白含量和糖尿病病程行1∶1匹配,分析两组临床疗效。结果： 随访24个月,无主要并发症和营养不良发生。两种术式均明显减重及改善糖脂代谢水平。与LSG相比,LRYGB组术后24个月的血清总胆固醇[（4.31±0.94） mmol/L比（5.36±1.22） mmol/L,P<0.01]和低密度脂蛋白c水平[（2.39±0.70） mmol/L比（3.22±0.94） mmol/L, P<0.01]改善更显著,糖化血红蛋白缓解率更高（89.5%比71.1%,P=0.044）。结论： LRYGB与LSG均能在术后短期显著减重及改善糖脂代谢紊乱。相较LSG,LRYGB降低糖化血红蛋白与改善血脂异常的疗效更显著。

关键词: 2型糖尿病, 肥胖, 腹腔镜Roux-en-Y胃旁路术, 腹腔镜袖状胃切除术

Abstract:

Objective To compare the short-term effect of bariatric surgery on obesity patients with type 2 diabetes mellitus between laparoscopic Roux-en Y gastric bypass (LRYGB) and laparoscopic sleeve gastrectomy (LSG). Methods A retrospective study was performed from January 2011 to December 2018 for the obesity patients with type-2 diabetes who underwent LRYGB (n=38) and LSG (n=38) and matched in age, gender, body mass index, glycosylated hemoglobin A1c level, and diabetes duration to analyze the surgical effects. Results There was no any major complication and no any malnutrition during 24 months of follow-up. Both surgical procedures achieved weight loss and diabetes remission significantly. LRYGB reduced serum cholesterol levels [(4.31±0.94) mmol/L vs. (5.36±1.22) mmol/L, P<0.01] and low-density lipoprotein-c levels [(2.39±0.70) mmol/L vs. (3.22±0.94) mmol/L, P<0.01], as well as diabetes remission rate by glycosylated hemoglobin A1c (89.5% vs. 71.1%, P=0.044) significantly when compared with LSG. Conclusions Both LRYGB and LSG could get significant weight loss and disorders remission of glucose and lipid metabolism in short-term postoperatively. LRYGB may have a more favorable effect on reducing glycosylated hemoglobin A1c level and improving dyslipidemia compared with LSG.

Key words: Type 2 diabetes mellitus, Obesity, Laparoscopic Roux-en-Y gastric bypass, Laparoscopic sleeve gastrectomy

中图分类号:

R589.2

张晨阳, 张弘玮, 韩晓东, 刘伟杰, 于浩泳, 张频. 腹腔镜Roux-en-Y胃旁路术与腹腔镜袖状胃切除术减重与改善代谢紊乱的比较研究[J]. 外科理论与实践, 2020, 25(05): 397-401.

ZHANG Chenyang, ZHANG Hongwei, HAN Xiaodong, LIU Weijie, YU Haoyong, ZHANG Pin. Comparative study on weight loss and remission of metabolic disorders after laparoscopic Roux-en-Y gastric bypass versus laparoscopic sleeve gastrectomy[J]. Journal of Surgery Concepts & Practice, 2020, 25(05): 397-401.

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参考文献 20

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项目	LRYGB (n=38)	LSG (n=38)	P值
年龄（岁）	43.94±11.45	44.63±11.10	0.792
糖尿病病程（年）	5.47±4.86	5.10±5.46	0.757
男	18	18
女	20	20
BMI	35.07±3.96	35.47±4.12	0.668
HbA1c（%）	7.96±1.68	7.85±1.68	0.770

指标	组别	术前	术后3个月	术后6个月	术后12个月	术后24个月
BMI	LRYGB	35.07±3.96	28.18±3.21^**	26.89±3.11^**	26.60±2.63^**	26.93±2.81^**
	LSG	35.47±4.12	28.90±3.79^**	26.73±3.53^**	26.07±3.55^**	27.09±3.66^**
收缩压 (mmHg)	LRYGB	138.07±16.16	129.14±17.07^**	125.12±13.80^**	125.80±10.94^**	126.50±15.51^**
	LSG	136.45±18.14	132.72±14.28	127.03±17.93^*	123.96±14.95^**	127.00±15.13^*
舒张压(mmHg)	LRYGB	85.21±10.88	81.26±11.46	78.09±9.27^**	78.73±7.31^**	77.40±10.37^**
	LSG	87.25±11.13	83.27±11.59	82.21±10.79	78.06±9.99^**	80.40±12.55^*
HbA1c (%)	LRYGB	7.96±1.68	5.75±0.75^**	5.68±0.76^**	5.75±0.66^**	5.87±0.81^**
	LSG	7.85±1.68	5.84±0.65^**	5.75±0.78^**	5.77±0.75^**	5.71±0.68^**
FPG(mmol/L)	LRYGB	8.41±2.54	5.46±1.22^**	5.22±0.91^**	5.56±1.21^**	5.39±0.92^**
	LSG	8.29±2.56	5.44±0.86^**	5.35±0.97^**	5.30±1.02^**	5.14±0.59^**
PBG(mmol/L)	LRYGB	13.61±4.22	6.56±2.14^**	6.64±2.41^**	6.53±2.48^**	6.40±2.26^**
	LSG	12.83±3.75	6.55±1.94^**	5.89±1.57^**	6.22±2.45^**	5.87±1.49^**
HOMA-IR	LRYGB	6.42(4.96,11.27)	2.02(1.21,3.62)^**	1.42(1.03,2.39)^**	1.44(1.19,2.72)^**	1.32(1.14,2.79)^**
	LSG	7.78(4.95,11.31)	1.97(1.40, 2.76)^**	1.61(1.20,2.15)^**	1.61(0.96,2.14)^**	1.83(1.30,2.36)^**
空腹C肽(nmol/L)	LRYGB	1.09±0.09	0.85±0.07^**	0.77±0.05^**	0.69±0.04^**	0.69±0.05^**
	LSG	1.21±0.09	0.87±0.06^**	0.68±0.04^**	0.72±0.05^**	0.73±0.05^**
空腹胰岛素(pmol/L)	LRYGB	18.99(12.77,30.1)	8.10(5.91,14.45)^**	6.56(4.51,8.87)^**	6.76(4.85,11.39)^**	6.15(4.54,12.64)^**
	LSG	20.85(13.50,29.1)	8.25(5.85,11.05)^**	6.86(4.47,9.31)^**	7.15(4.95,9.08)^**	7.74(5.80,9.86)^**

指标	组别	术前	术后3个月	术后6个月	术后12个月	术后24个月
Tc (mmol/L)
	LRYGB	5.44±1.84	4.29±0.87^**	4.04±0.79^**	4.19±0.92^**	4.31±0.94^**
	LSG	5.05±1.28	5.41±1.08^##	5.08±1.09^##	4.99±1.05^##	5.36±1.22^##
Tg (mmol/L)
	LRYGB	3.19±2.97	1.40±0.67^**	1.23±0.57^**	1.11±0.41^**	1.25±0.53^**
	LSG	2.71±1.91	1.47±0.63^**	1.25±0.48^**	1.11±0.41^**	1.28±0.79^**
HDL-c (mmol/L)
	LRYGB	1.03±0.23	1.04±0.22	1.16±0.23^*	1.26±0.2^**	1.26±0.29^**
	LSG	0.99±0.14	1.08±0.24^**	1.19±0.26^**	1.28±0.29^**	1.34±0.36^**
LDL-c (mmol/L)
	LRYGB	2.97±0.85	2.55±0.73^**	2.25±0.7^**	2.32±0.64^**	2.39±0.70^**
	LSG	2.95±0.94	3.42±0.83^##*	3.16±0.91^##	2.98±0.96^##	3.22±0.94^##
ASI
	LRYGB	4.57±2.85	3.23±1.01^**	2.54±0.81^**	2.35±0.77^**	2.53±0.91^**
	LSG	4.19±1.49	4.19±1.45^##	3.47±1.43^##*	3.03±1.15^##**	3.18±1.09^##**

时间	LRYGB	LSG	P值
术前	6(15.8)	9(23.7)	0.387
术后3个月	31(81.6)	25(65.8)	0.118
术后6个月	35(92.1)	28(73.7)	0.033
术后12个月	33(86.8)	28(73.7)	0.150
术后24个月	34(89.5)	27(71.1)	0.044