腹腔镜胃旁路术和袖状胃切除术治疗肥胖合并2型糖尿病患者的长期疗效比较

目的 比较腹腔镜Roux-en-Y胃旁路术(laparoscopic Roux-en-Y gastric bypass,LRYGB)和袖状胃切除术(laparoscopic sleeve gastrectomy,LSG)治疗肥胖合并2型糖尿病(type 2 diabetes mellitus,T2DM)患者的长期疗效.方法 回顾性分析2010年1月至2013年6月在北京世纪坛医院接受LRYGB和LSG的63例T2DM患者,按手术方式分为两组:LRYGB组28例,LSG组35例.结果 术后1、3、5年,两组患者的BMI、空腹血糖、空腹胰岛素、HbA1c、胰岛素抵抗指数均较术前明显降低[LRYGB组:(37.3 ±3.7) kg/m2比(32.3±3.4) kg/m2比(28.8 ±3.0) kg/m2比(25.5 ±2.8)kg/m2,t=13.670,15.499,21.710,P=0.000,0.000,0.000;(8.2±1.8) mmol/L比(6.0±1.3)mmol/L比(5.2 ±0.9) mmol/L比(4.7 ±0.5)mmol/L,t =6.664,8.723,10.282,P =0.000,0.000,0.000;(32.2±17.0) μIU/ml比(16.1 ±12.1)μIU/ml比(8.6 ±5.2) μIU/ml比(5.2 ±2.8) μIU/ml,t =7.453,8.218,8.687,P=0.000,0.000,0.000;(7.4％±0.6％)比(6.2％±0.7％)比(5.7％±0.7％)比(5.1％±0.6％),t=11.362,18.771,21.186,P =0.000,0.000,0.000;(12.0 ±7.3)比(4.6±4.3)比(2.1±1.7)比(1.1±0.7),t=6.455,7.667,8.050,P=0.000,0.000,0.000. LSG组:(39.2 ±5.2) kg/m2比(34.1±4.5)kg/m2比(29.3±4.0)kg/m2比(25.1±2.3)kg/m2,t=11.676,13.680,19.161,P=0.000,0.000,0.000;(8.0±2.9) mmol/L比(5.8±1.5) mmol/L比(5.1±0.9)mmol/L比(4.6±0.5) mmol/L,t =5.467,6.921,7.741,P =0.000,0.000,0.000;(29.1 ±25.2) μIU/ml比(16.4 ±10.6)μIU/ml比(8.8 ±5.5) μIU/ml比(5.5 ±2.0) μIU/ml,t =3.512,5.232,5.702,P =0.001,0.000,0.000;(7.7％±1.3％)比(6.3％±0.6％)比(5.8％±0.6％)比(5.2％ ±0.6％),t=8.001,10.106,11.922,P =0.000,0.000,0.000;(9.8 ±9.6)比(3.9±2.2)比(1.9±1.0)比(1.1 ±0.4),t =3.733,4.972,5.404,P=0.001,0.000,0.000].两组患者手术前后的BMI、空腹血糖、空腹胰岛素、HbA1c、胰岛素抵抗指数差异均无统计学意义(均P＞0.05).两组患者术后1、3、5年的糖尿病完全缓解率差异均无统计学意义(71％比69％ 、89％比80％ 、93％比89％,均P＞0.05).结论 LRYGB和LSG治疗T2DM患者的长期疗效相同.