CAJ | 학술논문

目的观察胃转流术(GBP)对非肥胖型2型糖尿病(T2DM)患者的治疗作用.方法前瞻性纳入2008年6月至2010年4月南京军区福州总医院合并非肥胖型T2DM的胃部病变行GBP 47例,其中全胃切除Roux-en-Y式20例、胃大部切除Roux-en-Y式13例和毕Ⅱ式14例.测量术前(0周),术后1周、2周和1、3、6个月体质量指数(BMI)、空腹血糖及胰高血糖素样肽-1(GLP-1)水平,检测术前、术后3、6个月糖化血红蛋白(HbA1c),术后糖尿病转归情况.结果与术前比较,3组术后1周至6个月空腹血糖均显著降低(P＜0.01),GLP-1水平术后升高(P＜0.01或P＜0.05)；术后3至6个月HbA1c显著降低(P＜0.01或P＜0.05),其中胃大部切除及全胃切除Roux-en-Y式组上述指标变化幅度显著＞毕Ⅱ式组(P＜0.05).术后6个月,毕Ⅱ式和胃大部切除及全胃切除Roux-en-Y式组糖尿病手术总有效率分别为78.5％ (11/14)、100％ (13/13)和100％ (20/20),其中Roux-en-Y式组总有效率显著高于毕Ⅱ式组(P＜0.05).3组术后1月至6个月体质量指数均显著低于术前(P＜0.05),组间差异无统计学意义(P＞0.05).结论 3种胃肠道重建术均有降糖效果,其中Roux-en-Y式GBP对T2DM的疗效优于毕Ⅱ式,且并不依赖于体质量的降低.
목적 관찰위전류술(GBP)대비비반형2형당뇨병(T2DM)환자적치료작용.방법 전첨성납입2008년6월지2010년4월남경군구복주총의원합병비비반형T2DM적위부병변행GBP 47례,기중전위절제Roux-en-Y식20례、위대부절제Roux-en-Y식13례화필Ⅱ식14례.측량술전(0주),술후1주、2주화1、3、6개월체질량지수(BMI)、공복혈당급이고혈당소양태-1(GLP-1)수평,검측술전、술후3、6개월당화혈홍단백(HbA1c),술후당뇨병전귀정황.결과 여술전비교,3조술후1주지6개월공복혈당균현저강저(P＜0.01),GLP-1수평술후승고(P＜0.01혹P＜0.05)；술후3지6개월HbA1c현저강저(P＜0.01혹P＜0.05),기중위대부절제급전위절제Roux-en-Y식조상술지표변화폭도현저＞필Ⅱ식조(P＜0.05).술후6개월,필Ⅱ식화위대부절제급전위절제Roux-en-Y식조당뇨병수술총유효솔분별위78.5％ (11/14)、100％ (13/13)화100％ (20/20),기중Roux-en-Y식조총유효솔현저고우필Ⅱ식조(P＜0.05).3조술후1월지6개월체질량지수균현저저우술전(P＜0.05),조간차이무통계학의의(P＞0.05).결론 3충위장도중건술균유강당효과,기중Roux-en-Y식GBP대T2DM적료효우우필Ⅱ식,차병불의뢰우체질량적강저.
Objective To observe therapeutical effects of gastric bypass on non-obese type 2 diabetes patients.Methods From June 2008 to April 2010,data of 47 patients with both gastric lesions and non-obese type 2 diabetes mellitus undergoing gastric bypass in the Institute of General Surgery were studied.The patients were divided into 3 groups according to the operation type:total stomach resection plus Roux-en-Y anastomosis ( n =20),partial stomach resection plus Roux-en-Y anastomosis(n =13)and Billroth Ⅱ gastrectomy(n =14).They were followed for 6 months after surgery.Level of body mass index (BMI),fasting blood glucose (FBG) and GLP-1 was measured before operation and on the 1 st week,2nd week,1 st month,3rd month,and 6th month after operation.The level of glycosylated hemoglobin was measured before operation and on the 3rd and 6th month after operation.The prognosis of the patients on the 6th month after surgery was evaluated.Results Compared with preoperative level,FBG level in all the 3 groups significantly decreased on the 1 st week after surgery and maintained a similar level during the follow-up period (P ＜ 0.01 ).GLP-1 level was elevated after operation (P ＜0.01 or P ＜ 0.05).On the 3rd and 6th month after operation,glycosylated hemoglobin level in all the 3 groups significantly decreased (P ＜ 0.01 or P ＜ 0.05 ).The change of the above parameters was greater in groups undergoing Roux-en-Y anastomosis than in Billroth Ⅱ group(P ＜ 0.05 ).The control rate of T2DM for Billroth Ⅱ,partial stomach resection plus Roux-en-Y anastomosis and total stomach resection plus Roux-en-Y anastomosis was 78.5％(11/14),100％ (13/13) and 100％ (20/20)respectively on the 6th month after surgery,indicating Roux-en-Y gastric bypass had better effect of blood glucose control than Billroth Ⅱ (P ＜ 0.05 ).Postoperative BMI decreased significantly in all groups (P ＜ 0.05) and there was no statistical difference between all the groups (P ＞ 0.05 ).Conclusions All groups of gastric bypass are effective in terms of glucose control.Roux-en-Y gastric bypass is more effective than Billroth Ⅱ on diabetes control and its therapeutic effect is independent of weight loss.