腹腔镜胃袖状切除术联合十二指肠空肠吻合术与腹腔镜Roux-en-Y胃旁路术治疗非肥胖型2型糖尿病的疗效比较

摘要

目的 比较腹腔镜胃袖状切除术+十二指肠空肠吻合术和腹腔镜Roux-en-Y胃旁路术治疗非肥胖型(BMI＜ 30 kg/m2)2型糖尿病患者的近期疗效.方法 回顾性分析2012年1月至2013年6月南京医科大学第一附属医院接受手术治疗的BMI＜ 30 kg/m2的42例2型糖尿病患者的临床资料.15例患者行腹腔镜胃袖状切除术+十二指肠空肠吻合术(Sleeve+ DJB组),27例行腹腔镜Roux-en-Y胃旁路术(RYGB组).所有患者随访时间＞6个月.比较两组患者术后BMI下降情况,糖尿病完全缓解率,空腹血糖和糖化血红蛋白下降情况,以及术后营养和并发症发生情况.计量资料采用t检验和重复测量的方差分析,计数资料用x2检验.结果 Sleeve+DJB组和RYGB组的手术时间分别为(137±61) min和(89±43) min,两组比较,差异有统计学意义(t=6.158,P ＜0.05).无患者死亡,无大出血、肠梗阻、吻合口狭窄等严重并发症发生.Sleeve+ DJB组1例患者术后发生胆汁漏,经保守治疗5d后痊愈出院.Sleeve+DJB组患者术前和术后1、3、6个月的空腹血糖水平分别为(8.9±0.7) mmol/L、(5.8±1.3) mmol/L、(5.6±1.8) mmol/L、(5.7±0.3)mmol/L,RYGB组患者分别为(9.9±1.2) mmol/L、(6.9±0.8)mmol/L、(6.6±2.2) mmol/L、(5.6±0.8)mmol/L,两组比较,差异无统计学意义(F=1.670,2.932,0.444,0.158,P＞0.05).Sleeve+ DJB组患者术前和术后1、3、6个月的糖化血红蛋白值分别为7.4％±1.4％、6.5％±0.6％、5.7％±0.5％、5.9％±0.6％,RYGB组患者分别为7.7％±2.0％、6.8％±1.3％、5.7％±0.8％、5.6％±1.1％,两组比较,差异无统计学意义(F =0.055,0.125,0.005,0.286,P＞0.05).Sleeve+ DJB组和RYGB组患者术后6个月糖尿病完全缓解率分别为14/15和74.1％(20/27),两组比较,差异无统计学意义(x2=2.320,P ＞0.05).Sleeve+ DJB组和RYGB组患者BMI下降比例分别为l8.2％±9.5％和21.2％±4.9％,两组比较,差异无统计学意义(t =0.982,P ＞0.05).Sleeve+ DJB组和RYGB组患者术后出现贫血、维生素缺乏、腹泻分别为0、0、2例和3、2、6例,两组比较,差异无统计学意义(x2=1.795,1.167,0.908,P＞0.05).所有患者术后6个月BMI＞ 19 kg/m2.结论 胃袖状切除术+十二指肠空肠吻合术和Roux-en-Y胃旁路术对于非肥胖型2型糖尿病患者的治疗效果和术后相关并发症发生率相当.胃袖状切除术+十二指肠空肠吻合术对患者营养状况的干扰略低于Roux-en-Y胃旁路术.%Objective To investigate the efficacies of laparoscopic sleeve gastrectomy + duodenojejunal bypass (DJB) and laparoscopic gastric bypass in the treatment of patients with non-obese type 2 diabetes mellitus (T2DM).Methods The clinical data of 42 patients with type 2 diabetes mellitus and body mass index (BMI) ＜ 30 kg/m2 received surgical treatment at the First Affiliated Hospital of Nanjing Medical University from January 2012 to June 2013 were retrospectively analyzed.Fifteen patients received laparoscopic sleeve gastrectomy + DJB (Sleeve + DJB group),and 27 received Roux-en-Y gastric bypass (RYGB group).The follow-up time for all the patients was more than 6 months.The decrease of BMI,complete remission of T2DM,decrease of fasting glycemia and glycosylated hemoglobin (HbAlc),postoperative nutritional condition and the incidence of complications of the 2 groups were compared.The measurement data were analyzed using the t test and the repeated measurement chi-square test.Results The operation time of the Sleeve + DJB group and the RYGB group were (137 ± 61)minutes and (89 ± 43) minutes,with significant difference between the 2 groups (t =6.158,P ＜ 0.05).No mortality and hemorrhage,bowel obstruction and anastomotic stenosis were detected.One patient was complicated with bile leakage in the Sleeve + DJB group,and was cured by conservative treatment 5 days later.The levels of fasting glucose before operation and at postoperative month 1,3,6 were (8.9 ± 0.7) mmol/L,(5.8 ± 1.3) mmoL/L,(5.6 ±1.8) mmol/L and (5.7 ± 0.3) mmol/L in the Sleeve + DJB group,and (9.9 ± 1.2) mmol/L,(6.9 ± 0.8) mmol/L,(6.6 ± 2.2) mmol/L and (5.6 ± 0.8) mmol/L,with no significant difference between the 2 groups (F =1.670,2.932,0.444,0.158,P ＞ 0.05).The levels of HbAle before operation and at postoperative months 1,3,6 were 7.4％± 1.4％,6.5％ ±0.6％,5.7％±0.5％,5.9％ ±0.6％ in the Sleeve + DJB group,and 7.7％± 2.0％,6.8％ ± 1.3％,5.7％±0.8％,5.6％ ± 1.1％ in the RYGB group,with no significant difference between the 2 groups (F =0.055,0.125,0.005,0.286,P ＞ 0.05).The remission rates of T2DM of the Sleeve + DJB group and the RYGB group were 14/15 and 74.1％ (20/27) at postoperative month 6,with no significant difference between the 2 groups (x2 =2.320,P ＞ 0.05).The decrease rate of BMI of the Sleeve + DJB group and the RYGB group were 18.2％±9.5％ and 21.2％ ± 4.9％,with no significant difference between the 2 groups (t =0.982,P ＞0.05).The numbers of patients with postoperative anaemia,avitaminosis and diarrhea were 0,0,2 in the Sleeve + DJB group and 3,2,6 in the RYGB group,with no significant difference between the 2 groups (x2=1.795,1.167,0.908,P ＞0.05).The BMIs of all the patients were above 19 kg/m2.Conclusion The effects and incidence of postoperative complications of Sleeve + DJB for the treatment of T2DM are comparable to those of RYGB.Sleeve + DJB has less interference on the nutritional condition of patients compared with RYGB.