腹腔镜Roux-en-Y胃旁路术对2型糖尿病的影响。
Effect of laparoscopic Roux-en Y gastric bypass on type 2 diabetes mellitus.
作者信息
Schauer Philip R, Burguera Bartolome, Ikramuddin Sayeed, Cottam Dan, Gourash William, Hamad Giselle, Eid George M, Mattar Samer, Ramanathan Ramesh, Barinas-Mitchel Emma, Rao R Harsha, Kuller Lewis, Kelley David
机构信息
Departments of Surgery, University of Pittsburg, Pittsburgh, PA, USA.
出版信息
Ann Surg. 2003 Oct;238(4):467-84; discussion 84-5. doi: 10.1097/01.sla.0000089851.41115.1b.
OBJECTIVE
To evaluate pre- and postoperative clinical parameters associated with improvement of diabetes up to 4 years after laparoscopic Roux-en-Y gastric bypass (LRYGBP) in patients with type 2 diabetes mellitus (T2DM).
SUMMARY BACKGROUND DATA
The surgical treatment of morbid obesity leads to dramatic improvement in the comorbidity status of most patients with T2DM. However, little is known concerning what preoperative clinical factors are associated with postoperative long-term improvement in diabetes in the morbidly obese patient with diabetes. METHODS We evaluated pre- and postoperative data, including demographics, duration of diabetes, metabolic parameters, and clinical outcomes, in all patients with impaired fasting glucose (IFG) and type T2DM undergoing LRYGBP from July 1997 to May 2002.
RESULTS
During this 5-year period, 1160 patients underwent LRYGBP and 240 (21%) had IFG or T2DM. Follow up was possible in 191 of 240 patients (80%). There were 144 females (75%) with a mean preoperative age of 48 years (range, 26-67 years). After surgery, weight and body mass index decreased from 308 lbs and 50.1 kg/m2 to 211 lbs and 34 kg/m2 for a mean weight loss of 97 lbs and mean excess weight loss of 60%. Fasting plasma glucose and glycosylated hemoglobin concentrations returned to normal levels (83%) or markedly improved (17%) in all patients. A significant reduction in use of oral antidiabetic agents (80%) and insulin (79%) followed surgical treatment. Patients with the shortest duration (<5 years), the mildest form of T2DM (diet controlled), and the greatest weight loss after surgery were most likely to achieve complete resolution of T2DM.
CONCLUSION
LRYGBP resulted in significant weight loss (60% percent of excess body weight loss) and resolution (83%) of T2DM. Patients with the shortest duration and mildest form of T2DM had a higher rate of T2DM resolution after surgery, suggesting that early surgical intervention is warranted to increase the likelihood of rendering patients euglycemic.
目的
评估2型糖尿病（T2DM）患者行腹腔镜Roux-en-Y胃旁路术（LRYGBP）后长达4年的糖尿病改善情况相关的术前和术后临床参数。
总结背景数据
病态肥胖的手术治疗可使大多数T2DM患者的合并症状况显著改善。然而，对于病态肥胖糖尿病患者术后糖尿病长期改善与哪些术前临床因素相关，人们知之甚少。方法：我们评估了1997年7月至2002年5月期间所有接受LRYGBP的空腹血糖受损（IFG）和T2DM患者的术前和术后数据，包括人口统计学、糖尿病病程、代谢参数和临床结局。
结果
在这5年期间，1160例患者接受了LRYGBP，其中240例（21%）患有IFG或T2DM。240例患者中有191例（80%）可以进行随访。有144名女性（75%），术前平均年龄为48岁（范围26 - 67岁）。术后，体重和体重指数从308磅和50.1kg/m²降至211磅和34kg/m²，平均体重减轻97磅，平均超重减轻60%。所有患者的空腹血糖和糖化血红蛋白浓度恢复到正常水平（83%）或显著改善（17%）。手术治疗后口服降糖药（80%）和胰岛素（79%）的使用显著减少。糖尿病病程最短（<5年）、T2DM最轻度形式（饮食控制）且术后体重减轻最多的患者最有可能实现T2DM的完全缓解。
结论
LRYGBP导致显著体重减轻（超重减轻60%）和T2DM缓解（83%）。糖尿病病程最短且T2DM形式最轻度的患者术后T2DM缓解率更高，提示早期手术干预对于提高患者血糖正常的可能性是必要的。
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