Yang Jing-ge, Wang Cun-chuan, Hu You-zhu, Li Jin-yi, Pan Yun-long, Shen Ying-ying, Li Yong-xin, Huang Jing, Yu Chun-liang, Liu Xian-ming
Department of Gastrointestinal Surgery, The First Affiliated Hospital, Jinan University, Guangzhou 510630, China.
Zhonghua Wei Chang Wai Ke Za Zhi. 2010 Aug;13(8):594-7.
To investigate the efficacy of laparoscopic Roux-en-Y gastric bypass (LRYGB) in the treatment for obesity and type 2 diabetes mellitus (DM).
Twenty-one cases of obesity and 9 cases of type 2 DM received the LRYGB. Weigh changes, excess body weight lose rate (EWL%) and blood glucose level were measured after surgery and occurrence of complications was observed postoperatively.
LRYGB procedures in all the 30 cases were successfully performed with no conversion to open surgery. Average operation time was 168 minutes (110-270 mins), volume of blood loss during the surgery was 24.0 ml (10-75 ml). Twenty-one cases of simple obesity received follow-up from 2 months to 5 years. Body weight and BMI decreased significantly in one month [(85.1+/-10.1) kg vs (97.2+/-15.0) kg, 31.2+/-2.2 vs 35.3+/-3.5, both P<0.01] and to a minimal level in 2 to 3 years [(66.8+/-9.2) kg, 24.3+/-1.1], and then maintained at this level. EWL% was correspondingly higher (all P<0.05). Nine type 2 DM patients were followed up for 3 to 8 months, fasting blood glucose and blood glucose OGTT2 hours decreased significantly [(5.9+/-1.4) mmol/L vs (12.6+/-2.6) mmol/L, (7.8+/-1.4) mmol/L vs (17.8+/-4.1) mmol/L, both P<0.05], of whom 4 patients with obesity decreased in BMI significantly (P<0.05), and 5 patients without obesity had no significant changes in BMI (P>0.05). Five cases (16.7%) had postoperative complications, including 1 case of death due to acute fulminant pancreatitis, 1 case of mesenteric hiatal hernia with obstruction in line for reoperation, and the other 3 cases of healing by conservative therapy.
Treatment of obesity and type 2 DM by LRYGB surgery is feasible with significant short term result. Long term outcome needs further observation.
探讨腹腔镜Roux-en-Y胃旁路术（LRYGB）治疗肥胖症及2型糖尿病（DM）的疗效。
21例肥胖症患者和9例2型糖尿病患者接受了LRYGB手术。术后测量体重变化、超重减轻率（EWL%）和血糖水平，并观察术后并发症的发生情况。
30例患者均成功实施LRYGB手术，无中转开腹手术。平均手术时间为168分钟（110 - 270分钟），术中失血量为24.0毫升（10 - 75毫升）。21例单纯肥胖症患者接受了2个月至5年的随访。术后1个月体重和BMI显著下降[（85.1±10.1）千克对（97.2±15.0）千克，31.2±2.2对35.3±3.5，均P<0.01]，并在2至3年降至最低水平[（66.8±9.2）千克，24.3±1.1]，然后维持在该水平。EWL%相应更高（均P<0.05）。9例2型糖尿病患者接受了3至8个月的随访，空腹血糖和OGTT2小时血糖显著下降[（5.9±1.4）毫摩尔/升对（12.6±2.6）毫摩尔/升，（7.8±1.4）毫摩尔/升对（17.8±4.1）毫摩尔/升，均P<0.05]，其中4例肥胖患者的BMI显著下降（P<0.05），5例非肥胖患者的BMI无显著变化（P>0.05）。5例（16.7%）出现术后并发症，包括1例因急性暴发性胰腺炎死亡，1例肠系膜裂孔疝伴梗阻等待再次手术，另外3例经保守治疗治愈。
LRYGB手术治疗肥胖症及2型糖尿病可行，短期效果显著。长期疗效有待进一步观察。
