[1]王　涛,师　振,于　飞.不同手术方案治疗重度肥胖合并2型糖尿病疗效比较[J].新乡医学院学报,2022,39(4):371-375.[doi:10.7683/xxyxyxb.2022.04.015]
　WAGN Tao,SHI Zhen,YU Fei.Comparison of curative effects of different surgical regimens in the treatment of severe obesity complicated with type 2 diabetes mellitus[J].Journal of Xinxiang Medical University,2022,39(4):371-375.[doi:10.7683/xxyxyxb.2022.04.015]
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不同手术方案治疗重度肥胖合并2型糖尿病疗效比较
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《新乡医学院学报》[ISSN:1004-7239/CN:41-1186/R]

卷:
39
期数:
2022年4
页码:
371-375
栏目:
临床研究
出版日期:
2022-04-05

文章信息/Info

Title:
Comparison of curative effects of different surgical regimens in the treatment of severe obesity complicated with type 2 diabetes mellitus
作者:
王　涛; 师　振; 于　飞
（黄河三门峡医院普外二区，河南　三门峡　472000）
Author(s):
WAGN Tao; SHI Zhen; YU Fei
（Department of No.2 General Surgery,Yellow River Sanmenxia Hospital,Sanmenxia 472000，Henan Province，China）
关键词:
肥胖; 2型糖尿病; 腹腔镜胃袖状切除; 空肠旁路术; 腹腔镜胃旁路术; 糖脂代谢
Keywords:
obesity; type 2 diabetes mellitus; laparoscopic sleeve gastrectomy; jejunojejunal bypass; laparoscopic Roux-en-Y gastric bypass; glucose and lipid metabolism
分类号:
R587.1
DOI:
10.7683/xxyxyxb.2022.04.015
文献标志码:
A
摘要:
目的　比较腹腔镜胃袖状切除术（LSG）、LSG联合空肠旁路术（JJB）和腹腔镜胃旁路术（LRYGB）治疗重度肥胖合并2型糖尿病（T2DM）的临床效果。方法　选择2017年8月至2020年8月黄河三门峡医院收治的80例重度肥胖合并T2DM患者为研究对象，根据手术方法将患者分为LSG组（n=29）、LSG+JJB组（n=25）和LRYGB组（n=26）。记录3组患者的手术时间、术中出血量、术后排气时间、住院时间。分别于术前、术后6个月抽取3组患者空腹静脉血5 mL，采用血糖仪检测空腹血糖（FPG）、糖化血红蛋白（HbAlc）水平，并计算胰岛素抵抗指数（HOMA-IR）。分别于术前、术后6个月抽取3组患者空腹静脉血5 mL，离心分离血清，采用全自动生物化学分析仪检测血清总胆固醇（TC）、三酰甘油（TG）、高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL-C）水平。记录3组患者术前、术后6个月体质量指数、腰围、臀围。结果　3组患者术中出血量、术后排气时间、住院时间比较差异无统计学意义（P>0.05）；LSG+JJB组和LRYGB组患者的手术时间显著长于LSG组（P<0.05），LRYGB组患者的手术时间显著长于LSG+JJB组（P<0.05）。术前、术后6个月3组患者的FPG、HbAlc、HOMA-IR比较差异无统计学意义（P>0.05）；3组患者术后6个月FPG、HbAlc、HOMA-IR均显著低于术前（P<0.05）。术前3组患者TC、TG、HDL-C、LDL-C水平比较差异无统计学意义（P>0.05）；3组患者术后6个月的TC、TG、LDL-C水平均显著低于术前，HDL-C水平均显著高于术前（P<0.05）；术后6个月，3组患者的TG、HDL-C、LDL-C水平比较差异无统计学意义（P>0.05），3组患者的TC水平比较差异有统计学意义（F=9.246，P<0.05），LSG+JJB组和LRYGB组患者的TC水平显著低于LSG组（P<0.05），LSG+JJB组和LRYGB组患者的TC水平比较差异无统计学意义（P>0.05）。术前 3组患者的体质量指数、腰围、臀围比较差异无统计学意义（P>0.05）；3组患者术后6个月的体质量指数、腰围、臀围均显著小于术前（P<0.05）；术后6个月，LSG+JJB组和LRYGB组患者的体质量指数、腰围、臀围均显著低于LSG组（P<0.05），LSG+JJB组和LRYGB组患者的体质量指数、腰围、臀围比较差异无统计学意义（P>0.05）。结论　LSG、LSG+JJB、LRYGB治疗均可改善重度肥胖合并T2DM患者糖脂代谢水平，起到较好的减重作用，但与LSG相比，LSG+JJB、LRYGB减重、降低胆固醇的效果更好，且LSG+JJB手术操作简单，较LRYGB更具优势。
Abstract:
Objective　To compare the clinical effect of laparoscopic sleeve gastrectomy (LSG),LSG+ jejunal bypass (JJB) and laparoscopic Roux-en-Y gastric bypass (LRYGB) in the treatment of severe obesity complicated with type 2 diabetes mellitus (T2DM).Methods　A total of 80 severe obese patients with T2DM who were admitted to the Yellow River Sanmenxia Hospital from August 2017 to August 2020 were selected as the research objects，and the patients were divided into LSG group (n=29),LSG+JJB group (n=25),LRYGB group (n=26) according to surgical methods.The operation time,intraoperative blood loss,postoperative exhaust time and hospital ization time of patients in the three groups were recorded.Before operation and 6 months after operation,5 mL of fasting venous blood was drawn from the patients in the three groups.The levels of fasting blood glucose (FPG) and glycated hemoglobin (HbAlc) were detected by blood glucose meter,and the homeostatic model assessment of insulin resistance (HOMA-IR) was calculated.Before operation and 6 months after operation,5 mL of fasting venous blood was drawn from the patients in the three groups,and serum was separated by centrifugation.The serum total cholesterol (TC),triacylglycerol (TG),high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C) levels were detected by automatic biochemical analyzer.The body mass index,waist circumference and hip circumference of patients in the three groups were recorded before and 6 months after operation.Results　There was no significant difference in the intraoperative blood loss,postoperative exhaust time and hospitalization time of patients among the three groups (P>0.05);the operation time of patients in the LSG+JJB group and LRYGB group was significantly longer than that in the LSG group (P<0.05);the operation time of patients in the LRYGB group was significantly longer than that in the LSG+JJB group (P<0.05).There was no significant difference in the FPG,HbAlc and HOMA-IR among the three groups before operation and 6 months after operation (P>0.05);the FPG,HbAlc and HOMA-IR of patients in the three groups at 6 months after operation were significantly lower than those before operation (P<0.05).There was no significant difference in the levels of TC,TG,HDL-C and LDL-C of patients among the three groups before operation (P>0.05);the levels of TC,TG and LDL-C of patients in the three groups at 6 months after operation were significantly lower than those before operation,the level of HDL-C was significantly higher than that before operation (P<0.05);6 months after operation,there was no significant difference in the level of TG,HDL-C and LDL-C of patients among the three groups (P>0.05),but there was significant difference in the level of TC of patients among the three groups (F=9.246,P<0.05),the TC level of patients in the LSG+JJB group and LRYGB group was significantly lower than that in the LSG group (P<0.05),and there was no significant difference in the TC level of patients between the LSG+JJB group and LRYGB group (P>0.05).There was no significant difference in the preoperative body mass index,waist circumference and hip circumference of patients among the three groups before operation (P>0.05);the body mass index,waist circumference and hip circumference of patients in the three groups at 6 months after operation were significantly smaller than those before operation (P<0.05);6 months after operation,the body mass index,waist circumference and hip circumference of patients in the LSG+JJB group and LRYGB group were significantly lower than those in the LSG group (P<0.05),and there was no difference in body mass index,waist circumference and hip circumference of patients between the LSG+JJB group and LRYGB group (P>0.05).Conclusion　LSG,LSG+JJB and LRYGB can improve the level of glucose and lipid metabolism of patients with severe obesity and T2DM,and play a better role in weight loss.However,LSG+JJB and LRYGB have better weight loss and cholesterol reduction effects compared with LSG.The LSG+JJB is simple and has more advantages than LRYGB.

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更新日期/Last Update: 2022-04-05