Department of Surgery, Hospital de Especialidades, Av. 136, no. 961, 14° andar, Setor Marista, 74.093-250, Goiânia, Goiás, Brazil.
J Gastrointest Surg. 2012 May;16(5):967-76. doi: 10.1007/s11605-011-1807-0. Epub 2012 Feb 18.
The objective of this study was to evaluate the mid-term outcomes of the laparoscopic ileal interposition into the jejunum (JII-SG) or into the duodenum (DII-SG) associated with sleeve gastrectomy for type 2 diabetes mellitus (T2DM) patients with BMI below 35.
The procedures were performed on 202 consecutive patients. Mean age was 52.2 ± 7.5. Mean duration of T2DM was 9.8 ± 5.2 years. Insulin therapy was used by 41.1%. Dyslipidemia was observed in 78.2%, hypertension in 67.3%, nephropathy in 49.5%, retinopathy in 31.2%, coronary heart disease in 11.9%, and other cardiovascular events in 12.9%.
Mean follow-up was 39.1 months (range, 25-61). Early and late mortality was 0.99% and 1.0%, respectively. Early reoperation was performed in 2.5%. Early and late major complications were 8.4% and 3.5%. Early most frequent complications were pneumonia and ileus. Intestinal obstruction was diagnosed in 1.5%. Mean BMI decreased from 29.7 to 23.5 kg/m(2), mean fasting glucose from 202.1 to 112.2 mg/dl, and mean postprandial glucose from 263.3 to 130 mg/dl. Triglycerides diminished from a mean of 273.4 to 110.3 mg/dl and cholesterol from a mean of 204.7 to 160.1 mg/dl. Hypertension was resolved in 87.5%. Mean hemoglobin A(1c) (HbA(1c)) decreased from 8.7 to 6.2% after the JII-SG and to 5.9% following the DII-SG. HbA(1c) below 7% was seen in 89.9% of the patients and below 6.5% in 78.3%. Overall, 86.4% of patients were off antidiabetic medications.
Both JII-SG and DII-SG demonstrated to be safe, effective, and long-lasting alternatives for the treatment of T2DM patients with BMI <35. Beyond glycemic control, other benefits were achieved.
本研究的目的是评估腹腔镜回肠间置术（JII-SG）或十二指肠间置术（DII-SG）联合袖状胃切除术治疗 BMI 低于 35 的 2 型糖尿病（T2DM）患者的中期结果。
该研究纳入了 202 例连续患者。平均年龄为 52.2±7.5 岁。T2DM 的平均病程为 9.8±5.2 年。41.1%的患者接受胰岛素治疗。78.2%的患者存在血脂异常，67.3%的患者存在高血压，49.5%的患者存在肾病，31.2%的患者存在视网膜病变，11.9%的患者存在冠心病，12.9%的患者存在其他心血管事件。
平均随访时间为 39.1 个月（25-61 个月）。早期和晚期死亡率分别为 0.99%和 1.0%。早期再手术率为 2.5%。早期和晚期主要并发症发生率分别为 8.4%和 3.5%。早期最常见的并发症是肺炎和肠梗阻。诊断出 1.5%的肠梗阻。BMI 从 29.7 降至 23.5kg/m2，空腹血糖从 202.1 降至 112.2mg/dl，餐后血糖从 263.3 降至 130mg/dl。甘油三酯从平均 273.4 降至 110.3mg/dl，胆固醇从平均 204.7 降至 160.1mg/dl。87.5%的高血压得到缓解。JII-SG 后平均糖化血红蛋白（HbA1c）从 8.7%降至 6.2%，DII-SG 后降至 5.9%。89.9%的患者 HbA1c 降至 7%以下，78.3%的患者降至 6.5%以下。总体而言，86.4%的患者停用了降糖药物。
JII-SG 和 DII-SG 均为 BMI<35 的 2 型糖尿病患者的安全、有效和持久的治疗选择。除了血糖控制外，还获得了其他益处。
