Chen Yijun, Corsino Leonor, Shantavasinkul Prapimporn Chattranukulchai, Grant John, Portenier Dana, Ding Laura, Torquati Alfonso
*Department of Surgery, David Geffen School of Medicine at the University of California, Los Angeles, CA†Department of Medicine, Division of Endocrinology, Metabolism, and Nutrition, Duke University, Durham, NC‡Department of Surgery, Duke Center for Metabolic and Bariatric Surgery, Duke University, Durham, NC§Division of Nutrition and Biochemical Medicine, Department of Medicine, Ramathibodi Hospital, Faculty of Medicine, Mahidol University, Bangkok, Thailand||Department of Biostatistics and Bioinformatics, Duke University, Durham, NC¶Rush University Center for Weight Loss and Bariatric Surgery, Chicago, IL.
Ann Surg. 2016 Jun;263(6):1138-42. doi: 10.1097/SLA.0000000000001509.
The aim of the study was to compare long-term outcomes of 2 groups of morbidly obese patients with type 2 diabetes mellitus-1 managed by Roux-en-Y gastric bypass surgery and a comparable group managed medically.
The present study was a single-institution retrospective study. Of the 173 obese patients with type 2 diabetes mellitus undergoing gastric bypass surgery between January 2000 and July 2004, 78 patients (45%) were followed for at least 10 years. The control group consisted of 80 diabetic obese patients from the same period with similar body mass index, age, race, and severity of diabetes. The median follow-up was 11 years for both the groups.
The group undergoing gastric bypass surgery had greater percentage of excess weight loss than the control group-66% versus -1.6%, respectively. Forty-one patients (52.6%) in the surgery group had complete remission of diabetes and 5 (6.4%) had partial remission. Twelve patients (15.4%) had diabetes recurrence after initial remission. No patient in the control group had remission of diabetes. Compared with the control group, the group undergoing gastric bypass surgery had a significantly reduced incidence of microvascular complications-46.3% versus 11.5%, and macrovascular complications-20.3% versus 5%, respectively (P < 0.01).
In this study, we demonstrated that after 10 years of follow-up, Roux-en-Y gastric bypass surgery, compared with nonsurgical medical management, resulted in significantly greater weight loss, reduction in hemoglobin A1c, and use of antidiabetic medications, and very importantly a lower incidence of both microvascular and macrovascular complications in obese patients with type 2 diabetes.
本研究旨在比较两组病态肥胖的2型糖尿病患者的长期预后，一组接受 Roux-en-Y 胃旁路手术治疗，另一组接受类似的药物治疗。
本研究是一项单机构回顾性研究。在2000年1月至2004年7月期间接受胃旁路手术的173例肥胖2型糖尿病患者中，78例（45%）患者随访至少10年。对照组由同期体重指数、年龄、种族和糖尿病严重程度相似的80例糖尿病肥胖患者组成。两组的中位随访时间均为11年。
接受胃旁路手术的组比对照组有更高的超重减轻百分比，分别为66% 和 -1.6%。手术组中有41例（52.6%）患者糖尿病完全缓解，5例（6.4%）部分缓解。12例（15.4%）患者在初始缓解后糖尿病复发。对照组中无患者糖尿病缓解。与对照组相比，接受胃旁路手术的组微血管并发症发生率显著降低，分别为46.3% 和11.5%，大血管并发症发生率分别为20.3% 和5%（P<0.01）。
在本研究中，我们证明，经过10年的随访，与非手术药物治疗相比，Roux-en-Y 胃旁路手术导致肥胖2型糖尿病患者体重减轻显著更多，糖化血红蛋白降低，抗糖尿病药物使用减少，非常重要的是微血管和大血管并发症发生率更低。
