摘要
目的探讨手术治疗肥胖合并2型糖尿病的规范化诊治及疗效。方法收集45例行腹腔镜胃旁路术的糖尿病患者的临床资料,随访并分析其手术前后的一般情况、各项实验室检查指标及并发症情况。结果 45例患者的平均年龄为(44.8±14.2)岁,平均糖尿病病程为(9.5±5.2)年。术后3、6个月患者的体重、腰围、体质指数均较术前显著降低(P值均<0.05)。术后1、3、6个月,患者的空腹血糖、餐后2h血糖、糖化血清白蛋白水平均较术前显著下降(P值均<0.05);糖化血红蛋白水平均较术前有下降趋势,但差异无统计学意义(P值均>0.05)。患者胰岛功能较术前恢复明显。术后3、6个月,患者的三酰甘油水平均较术前显著降低(P值均<0.05),高密度脂蛋白水平均较术前显著升高(P值均<0.05);术后3个月,患者的总胆固醇及低密度脂蛋白水平均较术前显著降低(P值均<0.05)。术后1、3、6个月,患者的维生素B、25羟-维生素D、血钙、血磷水平与术前比较,差异均无统计学意义(P值均>0.05)。术后1例患者因吻合口水肿致吻合口狭窄经保守治疗好转;3例肠梗阻患者,经保守治疗(2例)及行腹腔镜下束带粘连松解术(1例)后缓解。2例患者术后低血糖发作,予调整饮食规律后低血糖发作缓解。结论 2型糖尿病患者行胃旁路术后血糖得到理想控制,规范的治疗流程是手术取得良好疗效的重要保证之一。
Objective To investigate the standardized metabolic surgical procedure and clinical outcome in obesity patients with type 2 diabetes mellitus （T2DM）. Methods Clinical data of 45 patients who underwent Roux-en-Y gastric bypass were collected. The general state of health, laboratory examination and complications before and after surgery were retrospectively analyzed. Results The average age of the patients was （44.8 ±14.2） years and diabetes lasted for （9. 5 ±5. 2） years. The body weight, waistline and body mass index decreased significantly at 3 and 6 months after surgery as compared with that before surgery （all P〈0.05）. The levels of fasting blood glucose, 2-hour postprandial blood glucose and glycosylated serum albumin were decreased significantly at 1, 3 and 6 months after surgery （all P 〈 0. 05）. The level of glycosylated hemoglobin also decreased, but the difference before and after surgery was not statistically significant （all P〉0.05）. Pancreatic islet function was improved greatly. Triacylglycerol at 3 and 6 months after surgery was significantly lower than that before surgery （both P〈0.05）. Postoperative high density lipoprotein was significantly increased as compared with preoperative one （both P〈0.05）. Total cholesterol and low density lipoprotein at 3 months after surgery were significantly lower than before surgery （both P〈0.05）. There were no significant differences in vitamin B12, 25H-vitamin D, serum calcium or phosphorus before and after surgery （all P〉0.05）. Sternal edema occurred in one case and intestinal obstruction in three cases, which had been allaied by expectant treatment or surgery. Hypoglycemia occurred in two cases after surgery and was relieved after diet adjustment. Conclusion Serum glucose can be well controlled after gastric bypass. It is important to standardize the metabolic surgical procedure for satisfactory outcomes. （Shanghai Med J, 2013, 36 = 259-262）
出处
《上海医学》
CAS
CSCD
北大核心
2013年第3期259-262,共4页
Shanghai Medical Journal
关键词
2型糖尿病
肥胖
胃旁路术
疗效
随访
Type 2 diabetes dellitus
Obesity
Roux-en-Y gastric bypass
Clinical outcome
Follow-up
