腹腔镜袖状胃切除术和胃旁路术治疗肥胖合并2型糖尿病近期疗效的对比研究

摘要 目的：对比腹腔镜袖状胃切除术（LSG）和胃旁路术（LRYGB）治疗肥胖合并2型糖尿病（T2DM）的近期疗效。方法：回顾性分析我院于2016年2月至 2019年1月期间收治的63例肥胖合并T2DM患者的临床资料,根据患者手术方式,将患者分为LRYGB组34例、LSG组29例。对比两组术中、术后临床指标,对比两组术前、术后6个月的体质量指数（BMI）、腰臀比（WHR）、糖脂代谢指标,记录两组治疗期间并发症发生情况。结果：两组术后胃肠功能恢复时间、下床活动时间、术中出血量组间对比无统计学差异（P>0.05）,LSG组手术时间、住院时间短于LRYGB组（P<0.05）。两组术后6个月BMI、WHR均较术前下降（P<0.05）。两组术后6个月总胆固醇（TC）、糖化血红蛋白（HbAlc）、甘油三酯（TG）、低密度脂蛋白（LDL-C）、空腹血糖（FBG）、餐后2 h 血糖 （2hPG）均较术前下降（P<0.05）,高密度脂蛋白（HDL-C）较术前升高（P<0.05）。两组并发症发生率对比无统计学差异（P>0.05）。结论：LSG、LRYGB治疗肥胖合并T2DM患者,均可有效控制患者体重,调节血糖血脂,两者近期疗效相当,但是LSG的手术操作相对更简单,可视患者具体病情选择合适的术式。

Comparative Study on the Short-term Efficacy of Laparoscopic Sleeve Gastrectomy and Gastric Bypass in the Treatment of Obesity Complicated with Type 2 Diabetes Mellitus

ABSTRACT Objective: To compare the short-term efficacy of laparoscopic sleeve gastrectomy(LSG) and gastric bypass surgery (LRYGB) in the treatment of obese complicated with type 2 diabetes mellitus(T2DM). Methods: The clinical data of 63 obese patients with T2DM admitted to our hospital from February 2016 to January 2019 were retrospectively analyzed. According to the surgical methods, the patients were divided into LRYGB group with 34 cases and LSG group with 29 cases. The intraoperative and postoperative clinical indexes between the two groups were compared, body mass index (BMI), waist hip ratio (WHR) and glucose and lipid metabolism indexes of the two groups before and 6 months after operation were compared, and the complications of the two groups during treatment were recorded. Results: There were no significant differences in the the postoperative gastrointestinal function recovery time, activity time out of bed and intraoperative blood loss between the two groups(P>0.05). The operation time and hospital stay in LSG group were shorter than those in LRYGB group (P<0.05). BMI and WHR in the two groups at 6 months after operation were lower than those before operation (P<0.05). 6 months after operation, total cholesterol (TC), glycosylated hemoglobin (HbAlc), triglyceride (TG), low density lipoprotein (LDL-C), fasting blood glucose (FBG) and 2h postprandial blood glucose (2hPG) in the two groups were lower than those before operation (P<0.05), while HDL-C was higher than that before operation (P<0.05). There was no difference in the incidence rate of complications between the two groups (P>0.05). Conclusion: LSG and LRYGB in the treatment of obese patients with T2DM, which can effectively control body weight of patients, regulate blood glucose and lipid, and their short-term effects are similar, but the operation of LSG is relatively simple. The appropriate operation mode can be selected according to the specific condition of the patient.