CAJ | 학술논문

目的探讨腹腔镜Roux-en-Y胃旁路手术(LRYGB)治疗肥胖症和(或)2型糖尿病的可行性及疗效.方法对21例单纯性肥胖症及9例2型糖尿病患者施行LRYGB,观察肥胖症患者体质量、BMI、超重体质量减少率(EWL%)改善情况;观察糖尿病患者术后的空腹血糖和口服葡萄糖耐量试验(OGTT)变化情况;观察全组患者手术时间、术中出血量、术后恢复、术后并发症情况.结果本组30例皆成功完成手术,无中转开放手术者,手术时间110～270(平均168)min.术中出血量10～75(平均24.0)ml.本组21例单纯性肥胖症患者术前体质量及BMI分别为(97.2±15.0)kg和35.3±3.5;术后随访2个月至5年,术后1个月体质量及BMI即显著下降[(85.1±10.1)kg和31.2±2.2,均P<0.01],至术后2～3年降至最低水平[(66.8±9.2)kg和24.3±1.1],之后维持在此水平;EWL%则相应增高(均P<0.05).9例2型糖尿病患者术前空腹血糖及OGTT 2 h血糖分别为(12.6±2.6)mmol/L和(17.8±4.1)mmol/L;术后随访3～8个月,空腹血糖及OGTT2 h血糖均显著下降[(5.9±1.4)mmol/L和(7.8±1.4)mmol/L,均P<0.05];其中合并肥胖症的4例患者BMI明显降低(P<0.05),而5例未合并肥胖症者BMI无明显变化(P>0.05).本组30例患者中5例(16.7%)术后出现并发症,其中1例因急性暴发性胰腺炎死亡外,1例因肠系膜裂孔疝致肠梗阻行再次手术治愈,余3例均经保守治疗治愈.结论 LRYGB治疗肥胖症和(或)2型糖尿病手术安全可行,术后近期减重和(或)降糖效果显著.
목적 탐토복강경Roux-en-Y위방로수술(LRYGB)치료비반증화(혹)2형당뇨병적가행성급료효.방법 대21례단순성비반증급9례2형당뇨병환자시행LRYGB,관찰비반증환자체질량、BMI、초중체질량감소솔(EWL%)개선정황;관찰당뇨병환자술후적공복혈당화구복포도당내량시험(OGTT)변화정황;관찰전조환자수술시간、술중출혈량、술후회복、술후병발증정황.결과 본조30례개성공완성수술,무중전개방수술자,수술시간110～270(평균168)min.술중출혈량10～75(평균24.0)ml.본조21례단순성비반증환자술전체질량급BMI분별위(97.2±15.0)kg화35.3±3.5;술후수방2개월지5년,술후1개월체질량급BMI즉현저하강[(85.1±10.1)kg화31.2±2.2,균P<0.01],지술후2～3년강지최저수평[(66.8±9.2)kg화24.3±1.1],지후유지재차수평;EWL%칙상응증고(균P<0.05).9례2형당뇨병환자술전공복혈당급OGTT 2 h혈당분별위(12.6±2.6)mmol/L화(17.8±4.1)mmol/L;술후수방3～8개월,공복혈당급OGTT2 h혈당균현저하강[(5.9±1.4)mmol/L화(7.8±1.4)mmol/L,균P<0.05];기중합병비반증적4례환자BMI명현강저(P<0.05),이5례미합병비반증자BMI무명현변화(P>0.05).본조30례환자중5례(16.7%)술후출현병발증,기중1례인급성폭발성이선염사망외,1례인장계막렬공산치장경조행재차수술치유,여3례균경보수치료치유.결론 LRYGB치료비반증화(혹)2형당뇨병수술안전가행,술후근기감중화(혹)강당효과현저.
Objective To investigate the efficacy of laparoscopic Roux-en-Y gastric bypass (LRYGB)in the treatment for obesity and type 2 diabetes mellitus(DM).Methods Twenty-one cages of obesity and 9 cases of type 2 DM received the LRYGB.Weigh changes,excess body weight lose rate (EWL%)and blood glucose level were measured after surgery and occurrence of complications was observed postoperatively.Results LRYGB procedures in all the 30 cases were successfully performed with no conversion to open surgery.Average operation time was 168 minutes(110-270 mins),volume of blood loss during the surgery was 24.0 ml(10-75 ml).Twenty-one cases of simple obesity received follow-up from 2 months to 5 years.Body weight and BMI decreased significantly in one month[(85.1±10.1)kg vs(97.2±15.0)kg,31.2±2.2 vs 35.3±3.5,both P<0.01]and to a minimal level in 2 to 3 years [(66.8±9.2)kg,24.3±1.1],and then maintained at this level.EWL%was correspondingly higher(all P<0.05).Nine type 2 DM patients were followed up for 3 to 8 months,fasting blood glucose and blood glucose OGTT2 hours decreased significantly[(5.9±1.4)mmol/L vs(12.6±2.6)mmol/L,(7.8±1.4)mmol/L vs(17.8±4.1)mmol/L,both P<0.05],of whom 4 patients with obesity decreased in BMI significantly(P<0.05),and 5 patients without obesity had no significant changes in BMI(P>0.05).Five cases(16.7%) had postoperative complications,including 1 case of death due to acute fulminant pancreatitis,1 case of mesenteric hiatal hernia with obstruction in line for reoperation,and the other 3 cases of healing by conservative therapy.Conclusions Treatment of obesity and type 2 DM by LRYGB surgery is feasible with significant short term result.Long term outcome needs further observation.