腹腔镜下胃旁路手术治疗重度肥胖（BMI≥35）2型糖尿病

摘要

Objective To investigate the efficacy of laparoscopic gastric bypass surgery for severe obesity ( BMI≥35 ) with type 2 diabetes mellitus (T2DM). Methods According to the Type 2 Diabetes Prevention Guidelines of China (2010), 36 cases of severe obesity with type 2 diabetes were selected to undergo gastric bypass surgery.Follow-up data of the 36 patients (BMI≥35) with uncontrolled type 2 diabetes less than 15 years length between June 2012 and June 2013 were retrospectively analyzed. Results The body weight, BMI, waist circumference, hip circumference, waist-hip ratio, fasting plasma glucose, fasting insulin, fasting C-peptide, 2 h postprandial blood glucose, 2 h postprandial insulin, 2 h postprandial C-peptide, glycosylated hemoglobin, homeostasis model assessment for insulin resistance ( HOMA-IR), and percentage of excess weight loss (%EWL) at 1, 3, 6, and 12 months postoperatively were significantly improved (P<0.01) as compared to preoperative levels.The number of complete remission, partial remission and non-effect for T2DM was 33, 2, and 1, respectively, at 1 year after surgery.The total effective rate was 97.2%(35/36). Conclusions Laparoscopic gastric bypass surgery is an effective method of treatment to reduce weight and control blood glucose for severely obese patients with type 2 diabetes.Decrease of postprandial blood glucose plays a more important role in reducing glycated hemoglobin.%目的：探讨腹腔镜下胃旁路手术治疗重度肥胖（体重指数≥35）2型糖尿病的有效性。方法2012年6月～2013年6月，参照《中国2型糖尿病防治指南（2010）》选择体重指数（BMI）≥35、病史＜15年且药物治疗或使用胰岛素难以满意控制血糖及并发症的36例重度肥胖2型糖尿病患者实施腹腔镜胃旁路手术，并随访1年。结果术后1、3、6、12个月体重、BMI、腰围、臀围、腰臀比、空腹血糖、空腹胰岛素、空腹C肽、餐后2h血糖、餐后2h胰岛素、餐后2hC肽、糖化血红蛋白、胰岛素抵抗指数（HOMA－IR）、多余体重减少百分比（％EWL）与术前比较均明显改善（P＜0．01）。术后1年胃旁路手术治疗2型糖尿病完全缓解33例，明显改善2例，无效1例。有效率97．2％（35／36）。结论腹腔镜下胃旁路手术对国人重度肥胖伴2型糖尿病患者是一种有效的减重及降糖方法。餐后血糖下降在降低糖化血红蛋白中发挥更加重要的作用。