腹腔镜Roux-en-Y胃旁路术和袖状胃切除术治疗肥胖合并2型糖尿病的一年疗效对比研究

发布时间：2018-02-13 20:09

本文关键词： 腹腔镜Roux-en-Y胃旁路术腹腔镜袖状胃切除术肥胖 2型糖尿病　出处：《吉林大学》2017年硕士论文　论文类型：学位论文

【摘要】：背景:肥胖症已成为世界范围内流行的一种慢性病。伴随着肥胖症的发生,冠心病、高血压、脂肪肝、阻塞性睡眠呼吸暂停综合征等一系列代谢性疾病的发生率也不断提高,其中以2型糖尿病与肥胖症的关系最为密切。目前,减重代谢手术被认为是治疗肥胖合并2型糖尿病最有效的手段。其中,腹腔镜Roux-en-Y胃旁路术和袖状胃切除术的应用最为广泛。腹腔镜袖状胃切除术已由治疗重度肥胖患者第一阶段的术式转为治疗肥胖合并2型糖尿病的独立术式,具有手术操作简单,并发症少等优点。腹腔镜Roux-en-Y胃旁路术的疗效已得到人们的广泛认可,被认为是减重代谢手术的标准术式。本研究总结了自2015年2月至2016年2月于我科进行减重代谢手术的52例患者资料,通过分析患者接受两种术式前后血糖、血脂、体重及伴随疾病的缓解情况,进一步对比两种术式的临床疗效。目的:观察肥胖合并2型糖尿病患者行腹腔镜Roux-en-Y胃旁路术和袖状胃切除术前后血糖、血脂、体重等相关代谢指标的变化,术后并发症及2型糖尿病的缓解情况,并以此对两种手术方式的可行性、安全性和有效性进行对比研究。方法:回顾性分析2015年2月至2016年2月期间于我科接受减重代谢手术的肥胖合并2型糖尿病的52名患者的临床资料。按手术方式分为2组:LSG组和LRYGB组。其中LSG组患者29例,男性8例,女性21例,年龄(44±12)岁,体重(104.02±28.84)kg,BMI(36.37±7.83)kg/m2。LRYGB组患者23例,男性11例,女性12例,年龄(38±14)岁,体重(106.66±40.26)kg,BMI(37.28±14.31)kg/m2。患者入院后行系统检查,排除继发性肥胖及手术禁忌症后,在静脉吸入复合麻醉下分别行LSG及LRYGB两种手术方式。术后随访一年,观察并记录患者血糖、血脂、体重及相关代谢性疾病的缓解情况。各组数据采用SPSS19.0软件进行统计分析,均以均数±标准差表示,P0.05有统计学意义。结果:52例手术均顺利完成,无中转开腹及死亡的病例。LSG组与LRYGB组手术时间分别为(93.70±9.96)、(104.43±15.51)min,术后住院时间为(5.30±1.51)、(6.41±2.32)d,两组指标相比较,P值分别为0.000和0.031,均小于0.05。在术中出血量、术后排气时间和术后进流食时间方面,两组间比较差异无统计学意义。术后LSG组发生残胃腔狭窄1例,LRYGB组发生残胃出血1例,吻合口漏1例。两组术后3月、6月、12月的体重、BMI、空腹血糖、餐后2h血糖、糖化血红蛋白、空腹C肽、甘油三酯、胆固醇等代谢指标均较术前明显改善(P0.05)。术后一年LSG组2型糖尿病的完全缓解率为79.3%,有效率为100%;LRYGB组完全缓解率与有效率分别为86.9%和100%。2组缓解率无明显差别(P0.05)。结论:LSG与LRYGB两种手术方式均可有效的改善患者血糖、血脂、体重等相关代谢指标,治疗肥胖合并2型糖尿病,安全性及可行性较高,疗效肯定。短期效果较显著,长期效果仍有待研究。
[Abstract]:Background: obesity has become a worldwide epidemic chronic disease. With the occurrence of obesity, coronary heart disease, hypertension, fatty liver, obstructive sleep apnea syndrome and a series of metabolic diseases are also increasing. Among them, type 2 diabetes is most closely related to obesity. At present, weight-loss metabolic surgery is considered to be the most effective treatment for obesity with type 2 diabetes. Laparoscopic Roux-en-Y gastric bypass surgery and sleeve gastrectomy are the most widely used. Laparoscopic sleeve gastrectomy has changed from the first stage of treatment of severe obesity patients to the treatment of obesity with type 2 diabetes, the operation is simple. The efficacy of laparoscopic Roux-en-Y gastric bypass surgery has been widely recognized. This study summarized the data of 52 patients who underwent weight-loss metabolic surgery from February 2015 to February 2016, and analyzed the blood glucose and blood lipid of the patients before and after the two procedures. Objective: to observe the blood glucose and blood lipids before and after laparoscopic Roux-en-Y gastric bypass and sleeve gastrectomy in obese patients with type 2 diabetes. The changes of body weight and other related metabolic indexes, postoperative complications and the remission of type 2 diabetes mellitus, and the feasibility of the two surgical methods, Methods: the clinical data of 52 obese patients with type 2 diabetes undergoing weight-loss metabolic surgery from February 2015 to February 2016 were retrospectively analyzed. Two groups were divided into two groups: LSG group (n = 29) and LRYGB group (n = 29). Male 8, female 21, age 44 卤12 years, body weight 104.02 卤28.84 kg / kg BMIN 36.37 卤7.83 kg / m ~ (2) LRYGB group 23 patients, male 11, female 12, age 38 卤14), body weight 106.66 卤40.26 kg BMIM 37.28 卤14.31 kg 路m ~ (-2). The patients were followed up for one year to observe and record the remission of blood glucose, blood lipids, body weight and related metabolic diseases. The data of each group were analyzed by SPSS19.0 software. Results all 52 cases of operation were performed successfully. The operative time of LSG group and LRYGB group were 104.43 卤15.51 min and 5.30 卤1.51 卤6.41 卤2.32 days, respectively. The values of P were 0.000 and 0.031, respectively, which were less than 0.05.5.The blood loss, exhaust time and feeding time after operation were less than 0.05 in the two groups. There was no significant difference between the two groups. There were 1 case of residual gastric bleeding and 1 case of anastomotic leakage in the LSG group. The body weight of the two groups were measured on March, June and December, fasting blood glucose, 2 h postprandial blood glucose and glycosylated hemoglobin were found in the two groups. Fasting C-peptide, triglyceride, The complete remission rate of type 2 diabetes in the LSG group was 79.3, the effective rate was 86.9% and the effective rate in the 100g LRYGB group was 86.9% and 1000.There was no significant difference in the remission rate between the two groups (P0.050.Conclusion there is no significant difference in the remission rate between the two groups. Both LRYGB and LRYGB can improve blood glucose effectively. The treatment of obesity with type 2 diabetes is safe and feasible, and the curative effect is positive. The short-term effect is obvious, and the long-term effect is still to be studied.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R656.6;R589.2;R587.1

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