CAJ | 학술논문

目的评价袖状胃切除间置回肠的十二指肠空肠旁路手术对非肥胖型2型糖尿病的治疗效果.方法对符合纳入标准的非肥胖型2型糖尿病患者41例实施袖状胃切除间置回肠的十二指肠空肠旁路手术.观察术前及术后1、3、6个月患者的空腹血糖、餐后2h血糖、糖化血红蛋白、空腹胰岛素、空腹C肽、胰岛素抵抗指数(Homa-IR)、甘油三酯、高密度脂蛋白、低密度脂蛋白的变化及糖尿病并发症的缓解情况.结果对本组41例患者平均随访时间9.6个月(6～21个月).95％的患者术后糖化血红蛋白＜7％,不需任何降糖药物.78％的患者糖化血红蛋白＜6％.空腹血糖从术前的(9.7±0.4) mmol/L降至术后的(6.2±0.3)mmol/L(P＜0.01)；糖化血红蛋白从术前的8.1％±1.4％降至术后的5.8％±0.6％(P＜0.01)；餐后2h血糖从术前的(13.6±0.7) mmol/L降至术后的(10.6±0.2) mmol/L(P＜0.01)；Homa-IR从术前的4.8±1.3降至术后的1.2±0.4(P＜0.01)；空腹C肽从术前的(3.3±1.7) ng/ml升至术后的(4.9±0.2) ng/ml(P ＜0.01)；空腹胰岛素从术前的(10.2±1.4) mlu/L升至术后的(15.6±0.7) mlu/L(P ＜0.01)L；甘油三酯从术前的(3.1±0.5) mmol/L降至术后的(1.9±0.4) mmol/L(P ＜0.01)；高密度脂蛋白从术前的(1.2±0.2) mmol/L升至术后的(1.9±0.8) mmol/L(P ＜0.01)；低密度脂蛋白从术前的(3.5±0.3)mmol/L降至术后的(2.4±0.6)mmol/L(P＜0.01).7例合并高血压患者中3例的血压得到控制.78％(21/27例)患者的尿微量白蛋白得到缓解.53％(8/15例)患者的糖尿病视网膜病变得到改善.结论袖状胃切除间置回肠的十二指肠空肠旁路手术治疗非肥胖型2型糖尿病短期效果良好.
목적 평개수상위절제간치회장적십이지장공장방로수술대비비반형2형당뇨병적치료효과.방법 대부합납입표준적비비반형2형당뇨병환자41례실시수상위절제간치회장적십이지장공장방로수술.관찰술전급술후1、3、6개월환자적공복혈당、찬후2h혈당、당화혈홍단백、공복이도소、공복C태、이도소저항지수(Homa-IR)、감유삼지、고밀도지단백、저밀도지단백적변화급당뇨병병발증적완해정황.결과 대본조41례환자평균수방시간9.6개월(6～21개월).95％적환자술후당화혈홍단백＜7％,불수임하강당약물.78％적환자당화혈홍단백＜6％.공복혈당종술전적(9.7±0.4) mmol/L강지술후적(6.2±0.3)mmol/L(P＜0.01)；당화혈홍단백종술전적8.1％±1.4％강지술후적5.8％±0.6％(P＜0.01)；찬후2h혈당종술전적(13.6±0.7) mmol/L강지술후적(10.6±0.2) mmol/L(P＜0.01)；Homa-IR종술전적4.8±1.3강지술후적1.2±0.4(P＜0.01)；공복C태종술전적(3.3±1.7) ng/ml승지술후적(4.9±0.2) ng/ml(P ＜0.01)；공복이도소종술전적(10.2±1.4) mlu/L승지술후적(15.6±0.7) mlu/L(P ＜0.01)L；감유삼지종술전적(3.1±0.5) mmol/L강지술후적(1.9±0.4) mmol/L(P ＜0.01)；고밀도지단백종술전적(1.2±0.2) mmol/L승지술후적(1.9±0.8) mmol/L(P ＜0.01)；저밀도지단백종술전적(3.5±0.3)mmol/L강지술후적(2.4±0.6)mmol/L(P＜0.01).7례합병고혈압환자중3례적혈압득도공제.78％(21/27례)환자적뇨미량백단백득도완해.53％(8/15례)환자적당뇨병시망막병변득도개선.결론 수상위절제간치회장적십이지장공장방로수술치료비비반형2형당뇨병단기효과량호.
Objective To evaluate sleeve gastrectomy with ileal interposition and duodenojejunal bypass for the treatment of nonobese Type 2 diabetes mellitus.Methods Forty one patients of nonobese Type 2 diabetes mellitus underwent sleeve gastrectomy with ileal interposition and duodenojejunal bypass.Fasting glucose ( FPG ),glycosylated hemoglobin ( HbAlc ),fasting insulin and C-peptide,triglycerides (TG),high density lipoprotein(HDL),low density lipeprotein(LDL) were measured preoperatively and on postoperative first,3rd,6th month.Results Mean postoperative follow-up was 9.6 months (range 6-21 months).95％ patients achieved adequate glycemic control (HbAlc ＜ 7％ ) without antidiabetic medication.Fasting glycemia decreased from ( 9.7 ± 0.4 ) mmol/L to ( 6.2 ± 0.3 ) mmol/L ( P ＜ 0.01 ).Glycosylated hemoglobin decreased from 8.1％ ± 1.4％ to 5.8％ ± 0.6％ ( P ＜ 0.01 ).2-hour postprandial blood glucose decreased from ( 13.6 ± 0.7 ) mmol/L to ( 10.6 ± 0.2 ) mmol/L ( P ＜ 0.01 ).Insulin resistance (Homa-R) decreased from 4.8 ± 1.3 to 1.2 ±0.4 (P ＜0.01 ).Fasting C-peptide increased from ( 3.3 ± 1.7 ) ng/ml to (4.9 ± 0.2 ) ng/ml ( P ＜ 0.01 ).Fasting insulin increased from ( 10.2 + 1.4 ) mlu/L to (15.6±0.7) mlu/L(P＜0.01 ).Triglycerides (TG) decreased from (3.1 ±0.5) mmol/L to (1.9 ±0.4) mmol/L ( P ＜ 0.01 ).High density lipoprotein (HDL) increased from ( 1.2 ±± 0.2 ) mmol/L to ( 1.9 ±0.8 ) mmol/L( P ＜ 0.01 ).Low density lipoprotein (LDL) decreased from (3.5 ± 0.3 ) mmol/L to (2.4 ±0.6) mmol/L (P ＜0.01 ).Hypertension was controlled in 3/7 cases.Microalbuminuria resolved in 78％ patients.Retinopathy was improved in 53％ cases.Conclusions Sleeve gastrectomy with ileal interposition duodenojejunal bypass is effective for treatment of nonobese type 2 diabetes mellitus as showed by 6 month's follow-up.