摘要
目的探讨胃旁路术对非肥胖型2型糖尿病（T2DM）的疗效。方法前瞻性研究2008年11月至2009年8月第二军医大学附属长海医院收治的40例胃部疾病合并非肥胖型T2DM患者的临床资料，按实用性随机对照原则将患者分为4组，每组10例，分别接受毕Ⅰ式远端胃切除＋胃十二指肠吻合术（BI组）、近端胃大部切除＋食管残胃吻合术（PG组）、全胃切除＋Y型吻合术（RY组）、毕Ⅱ式胃空肠吻合术（BⅡ组），后2种术式为胃旁路术。比较4组患者住院时间、胃部疾病治疗情况、手术前后体质指数、腰围、空腹血糖、糖化血红蛋白、空腹血清胰岛素和空腹c肽水平等指标。数据采用方差分析、LSD—t检验、配对t检验、X2检验进行分析。结果4种术式对胃部疾病的疗效基本相同。RY组患者术前、术后6个月空腹血糖分别为（8．0±2．9）、（5．9±0．7）mmol／L，两者比较，差异有统计学意义（t=2．342，P〈0．05）。RY组患者术前糖化血红蛋白、空腹C肽分别为7．7％±1．1％、（1．30±0．54）μg/L，术后2、6个月分别为6．9％±0．6％、（1．95±0．86）μg／L和6．1％±0．4％、（2．18±0．63）μg／L，与术前比较，差异有统计学意义（t=4．920、6．063，3．012、4．651，P〈0．05）。RY组患者术前空腹血清胰岛素为（11±4）mU／L，术后1、2、6个月分别为（18±5）、（19±3）、（21±3）mU／L，与术前比较，差异有统计学意义（t=3．158，4．502，7．517，P〈0．05）。BⅡ组患者术前空腹血糖、糖化血红蛋白、空腹血清胰岛素和空腹血清c肽分别为（8．3±1．3）mmol／L、7．7％±0．9％、（13±4）mU／L、（1．34±0．48）μg/L，术后1、2、6个月分别为（6．7±1．2）mmol／L、6．8％±0．8％、（18±4）mU／L、（1．68±0．46）μg/L和（6．4±1．3）mmol／L、6．3％±0．6％、（18±4）mU／L、（1．96±0．67）μg／L及（5．6±0．7）mmol／L、6．0％±0．3％、（19±4）mU／L、（2．27±0．59）μg/L，与术前比较，差异有统计学意义（t=2．468、2．598、6．028，3．055、4．586、4．572，3．618、5．860、8．577，2．300、3．511、3．943，P〈0．05）。术后2、6个月4组患者空腹血糖、糖化血红蛋白、空腹C肽比较，差异有统计学意义（F=4．699、14．378，7．411、29．192，3．335、9．334，P〈0．05）。术后各时相点4组患者空腹血清胰岛素比较，差异有统计学意义（F=2．896，7．012，11．998，P〈0．05）。结论胃旁路术对非肥胖型T2DM具有较好疗效。
Objective To investigate the efficacy of gastric bypass surgery for the treatment of nonobese type 2 diabetes mellitus. Methods From November 2008 to August 2009, 40 patients with gastric diseases and nonobese type 2 diabetes mellitus were admitted to the Changhai Hospital, and their clinical data were prospectively studied. All patients were randomly divided into 4 groups： 10 patients received Billroth I distal gastrectomy ＋ gastroduodenal anastomosis （B I group）, 10 received proximal gastrectomy ＋ remanant gastric esophageal anas- tomosis （PG group ）, 10 received total gastrectomy ＋ esophagoduodenal Y-anastomosis （RY group ） and 10 received subtotal gastrectomy Billroth Ⅱ gastro-jejunostomy （ B Ⅱ group）. The length of hospital stay, pre- and postoperative body mass indexes （BMIs）, waist circumferences, levels of fasting blood glucose （FBG）, glycated hemoglobin （ GHbA1 ）, fasting serum insulin （FSI） and fasting C-peptide （FCP） of patients in the 4 groups were compared. All data were analyzed using analysis of variance, LSD-t test, paired t test or chi-square test. Results The clinical effects of the 4 different operative procedures on the gastric diseases were similar. The levels of FBG were （ 8.0 ±2.9 ） mmol/L before operation and （5.9±0.7 ） mmol/L after operation in the RY group, with a significant difference （t = 2. 342, P 〈 0. 05 ）. The preoperative level of GHbAI in the RY group was 7.7% ±1.1% , which was significantly higher than 6.9%±0.6% at 2 months after the operation and 6.1%±0.4% at 6 months after the operation （t =4. 920, 3. 012, P 〈0.05）. The preoperative level of FCP in the RY group was （ 1.30± 0.54）μg/L, which was significantly lower than （ 1.95± 0.86）μg/L at 2 months after the operation and （2.18 ± 0.63 ）μg/L at 6 months after the operation （ t = 6. 063, 4. 651, P 〈 0.05）. The levels of FSI in the RY group at postoperative month 1, 2 and 6 were （ 18 ± 5 ）, （ 19± 3 ）, （ 21 ± 3 ） mU/L, which were significantly higher than the level of FSI [ （11±4） mU/L] before operation （t =3. 158, 4. 502, 7. 517, P 〈0.05）. Pre-operative levels of FBG, GHbA1, FSI and FCP in the B Ⅱgroup were （8.3 - 1.3 ）mmol/L, 7.7%± 0.9%, （ 13 - 4） mU/L and （ 1.34 ± 0.48 ） μg/L, which were significantly different from （ 6.7 ±1.2 ） mmol/L, 6.8%±0.8% , （ 18± 4） mU/L and （ 1.68± 0.46）μg/L at postoperative month 1, （ 6.4± 1.3 ） mmol/L, 6.3% ＋ 0.6%, （ 18±4） mU/L and （ 1.96±0.67 ） μg/L at postoperative month 2, and （5.6 ± 0.7 ） mmol/L, 6.0%±0.3%, （ 19 ±4） mU/L and （2.27±0.59） μg/L at postoperative month 6 （ t = 2. 468, 2. 598, 6. 028 ; 3. 055, 4. 586, 4.572; 3.618, 5.860, 8.577; 2.300, 3.511, 3.943, P〈0.05）. The levelsofFBG,GHbA1 and FCPinthe 4 groups at 2 months after surgery were significantly different from those at 6 months after surgery （ F = 4. 699, 14. 378 ; 7.411, 29. 192; 3. 335, 9. 334, P 〈 0.05）. The levels of FSI in the 4 groups at different time points were significantly different （ F = 2. 896, 7. 012, 11. 998, P 〈 0.05 ）. Conclusion The efficacy of gastric bypass surgery for the treatment of nonobese type 2 diabetes mellitus is satisfactory.
出处
《中华消化外科杂志》
CAS
CSCD
2011年第3期206-209,共4页
Chinese Journal of Digestive Surgery
关键词
糖尿病
2型
胃旁路术
临床对照研究
非肥胖型
Diabetes mellitus, type 2
Gastric bypass surgery
Clinical controlled trials
. Nonobese type
