中华胃肠外科杂志
中華胃腸外科雜誌
중화위장외과잡지
CHINESE JOURNAL OF GASTROINTESTINAL SURGERY
2014年
7期
658-662
,共5页
常绪生%郑成竹%王鑫%卓光(鑽)%丁丹%郭翔%印慨
常緒生%鄭成竹%王鑫%卓光(鑽)%丁丹%郭翔%印慨
상서생%정성죽%왕흠%탁광(찬)%정단%곽상%인개
2型糖尿病,肥胖性%袖状胃切除术%腹腔镜手术%减重手术
2型糖尿病,肥胖性%袖狀胃切除術%腹腔鏡手術%減重手術
2형당뇨병,비반성%수상위절제술%복강경수술%감중수술
Obesity with T2DM%Sleeve gastrostomy%Laparoscopic surgery%Weight-loss surgery
目的 探讨腹腔镜袖状胃切除术(LSG)对肥胖性2型糖尿病(T2DM)的治疗效果及手术安全性.方法 回顾性分析2010年5月至2012年2月在第二军医大学附属长海医院微创外科接受LSG的32例肥胖性T2DM患者的临床资料.测量并计算患者术后1、3、6和12月的体质量指标[体质量、腰围、体质量指数(BMI)及多余体质量减少率(EWL)]、血糖指标[糖化血红蛋白(HbA1c)、空腹血糖(FPG)和胰岛素抵抗指数(HOMA-IR)]和血脂指标[血清总胆固醇、甘油三酯、低密度脂蛋白胆固醇(LDL-C)及高密度脂蛋白胆固醇(HDL-C)]水平,并与术前进行比较.结果 本组患者除1例因腹腔广泛粘连中转开腹,其余均在腹腔镜下完成手术.手术时间(115.0±19.6) min,术中出血量(69.0±29.7) ml.全组无手术死亡患者,无吻合口瘘、切口感染及腹腔脏器损伤发生.与术前相比,术后1、3、6和12月患者体质量、腰围及BMI均明显降低(P<0.05),且随时间呈下降趋势;而EWL呈明显上升趋势(P<0.05);随访12月,无体质量过低现象.从术后1月开始,患者HbA1c、FPG和HOMA-IR较术前明显降低(P<0.05);HbA1c和FPG分别从术后12月和术后6月处于基本稳定水平(P>0.05);术后3月有28例患者血糖已恢复正常.随访12月,T2DM临床完全缓解率87.5%(28/32),部分缓解率12.5%(4/32).血清总胆固醇、甘油三酯及LDL-C水平较术前明显降低(P<0.05).结论 对于肥胖性T2DM的患者,LSG是一种安全有效的手术方式.
目的 探討腹腔鏡袖狀胃切除術(LSG)對肥胖性2型糖尿病(T2DM)的治療效果及手術安全性.方法 迴顧性分析2010年5月至2012年2月在第二軍醫大學附屬長海醫院微創外科接受LSG的32例肥胖性T2DM患者的臨床資料.測量併計算患者術後1、3、6和12月的體質量指標[體質量、腰圍、體質量指數(BMI)及多餘體質量減少率(EWL)]、血糖指標[糖化血紅蛋白(HbA1c)、空腹血糖(FPG)和胰島素牴抗指數(HOMA-IR)]和血脂指標[血清總膽固醇、甘油三酯、低密度脂蛋白膽固醇(LDL-C)及高密度脂蛋白膽固醇(HDL-C)]水平,併與術前進行比較.結果 本組患者除1例因腹腔廣汎粘連中轉開腹,其餘均在腹腔鏡下完成手術.手術時間(115.0±19.6) min,術中齣血量(69.0±29.7) ml.全組無手術死亡患者,無吻閤口瘺、切口感染及腹腔髒器損傷髮生.與術前相比,術後1、3、6和12月患者體質量、腰圍及BMI均明顯降低(P<0.05),且隨時間呈下降趨勢;而EWL呈明顯上升趨勢(P<0.05);隨訪12月,無體質量過低現象.從術後1月開始,患者HbA1c、FPG和HOMA-IR較術前明顯降低(P<0.05);HbA1c和FPG分彆從術後12月和術後6月處于基本穩定水平(P>0.05);術後3月有28例患者血糖已恢複正常.隨訪12月,T2DM臨床完全緩解率87.5%(28/32),部分緩解率12.5%(4/32).血清總膽固醇、甘油三酯及LDL-C水平較術前明顯降低(P<0.05).結論 對于肥胖性T2DM的患者,LSG是一種安全有效的手術方式.
목적 탐토복강경수상위절제술(LSG)대비반성2형당뇨병(T2DM)적치료효과급수술안전성.방법 회고성분석2010년5월지2012년2월재제이군의대학부속장해의원미창외과접수LSG적32례비반성T2DM환자적림상자료.측량병계산환자술후1、3、6화12월적체질량지표[체질량、요위、체질량지수(BMI)급다여체질량감소솔(EWL)]、혈당지표[당화혈홍단백(HbA1c)、공복혈당(FPG)화이도소저항지수(HOMA-IR)]화혈지지표[혈청총담고순、감유삼지、저밀도지단백담고순(LDL-C)급고밀도지단백담고순(HDL-C)]수평,병여술전진행비교.결과 본조환자제1례인복강엄범점련중전개복,기여균재복강경하완성수술.수술시간(115.0±19.6) min,술중출혈량(69.0±29.7) ml.전조무수술사망환자,무문합구루、절구감염급복강장기손상발생.여술전상비,술후1、3、6화12월환자체질량、요위급BMI균명현강저(P<0.05),차수시간정하강추세;이EWL정명현상승추세(P<0.05);수방12월,무체질량과저현상.종술후1월개시,환자HbA1c、FPG화HOMA-IR교술전명현강저(P<0.05);HbA1c화FPG분별종술후12월화술후6월처우기본은정수평(P>0.05);술후3월유28례환자혈당이회복정상.수방12월,T2DM림상완전완해솔87.5%(28/32),부분완해솔12.5%(4/32).혈청총담고순、감유삼지급LDL-C수평교술전명현강저(P<0.05).결론 대우비반성T2DM적환자,LSG시일충안전유효적수술방식.
Objective To investigate the efficacy and safety of laparoscopic sleeve gastrectomy (LSG) for the treatment of obesity with type 2 diabetes mellitus (T2DM).Methods Clinical data of 32 obesity patients with T2DM patients undergoing LSG from May 2010 to February 2012 in our department were retrospectively analyzed.Their body weight indexes (body weight,waist circumference,BMI,EWL),blood glucose indexes [glycosylated hemoglobin (HbA1c),fasting plasma glucose (FPG),insulin resistance index (HOMA-IR)],and blood lipid indexes [total cholesterol,triglyceride,low density lipoprotein cholesterol (LDL-C),high density lipoprotein cholesterol (HDL-C)] were measured 1,3,6,12 months after operation and compared with preoperative levels.Improvement in complications was observed.Results All the patients completed operation under laparoscopy except 1 case because of abdominal cavity adhesion.The average operative time was (115.0±19.6) min,and the average blood loss (69.0 ±29.7) ml.No operative death,anastomotic leakage,or surgical site infection were found.The body weight,waist circumference and BMI at 1,3,6,and 12 months after surgery were significantly lower (all P<0.05) showing a decreasing trend over time.EWL showed significant increasing trend (P<0.05).During 12 months of follow-up,no over-low weight was observed.From 1 month after surgery,HbA1c,FPG and HOMA-IR decreased significantly (P<0.05).HbA1c and FPG maintained stable level at 12 and 6 months after operation respectively.FPG of 28 patients returned to normal 3 months after operation.Clinical complete remission rate of T2DM was 87.5%(28/32),and clinical partial remission rate was 12.5%(4/32) at the 12-month follow-up.Serum total cholesterol,triglyceride and LDL-C decreased obviously after surgery (P<0.05).Conclusion LSG procedure is a safe and effective surgical method in treatment of obesity with T2DM.