Gong Ke, Li Kai, Zhang Nengwei, Zhu Bin, Du Dexiao, Zhang Dongdong, Zhang Zhen, Peng Jirun
Department of General Surgery, Beijing Shijitan Hospital, Capital Medical University, No. 10, Tieyi Street, Yangfangdian Road, Haidian District, Beijing, 100038, China.
Surg Endosc. 2017 Mar;31(3):1172-1179. doi: 10.1007/s00464-016-5087-3. Epub 2016 Jul 15.
To evaluate the Roux-en-Y gastric bypass (GBP) procedure for patients suffering from type 2 diabetes mellitus (T2DM) with body mass index (BMI) <28 kg/m.
Thirty-one patients suffering from T2DM were selected to undergo laparoscopic Roux-en-Y gastric bypass surgery and were enrolled at Beijing Shijitan Hospital between November 2012 and December 2014. The fasting plasma glucose (FPG), glycosylated hemoglobin (HbA1c), C-peptide, fasting insulin (FINS) and glucagon-like peptide-1 (GLP-1) of all patients were measured before and at 1, 3, 6 months after surgery. The results were compared and analyzed.
Thirty-one patients suffering from T2DM successfully underwent GBP surgery (a mean age of 46 years), 14 were male and 17 were female. Among them, 7 patients had hypertriglyceridemia (HTG). The patients were followed up for 6 months. No major complications were found. The average BMI was 26.5 ± 1.4 kg/m before surgery. The average levels of FPG, HbA1c, C-peptide, FINS of all patients were statistically decreased after surgery, respectively, compared to those before surgery (P < 0.05). However, the mean GLP-1 of all patients was statistically increased after surgery compared to that before surgery (P < 0.05). At 6 months after surgery, 22 patients (71 %) achieved complete remission of T2DM with HbA1c < 6.5 %, 7 patients (23 %) gained partial remission of T2DM with 6.5 % ≤ HbA1c < 7.0 % and 2 patients (6 %) experienced no remission of T2DM. The mean serum triglyceride of 31 patients was statistically decreased after surgery compared to that before surgery (P < 0.05).
This research shows that the GBP procedure is safe and effective for T2DM patients with BMI <28 kg/m, and the condition of patients with HTG was greatly improved. However, further studies with larger samples and long-term follow-up are needed.
评估Roux-en-Y胃旁路术（GBP）对体重指数（BMI）<28kg/m²的2型糖尿病（T2DM）患者的疗效。
选取31例T2DM患者，于2012年11月至2014年12月在北京世纪坛医院接受腹腔镜Roux-en-Y胃旁路手术。测量所有患者术前及术后1、3、6个月的空腹血糖（FPG）、糖化血红蛋白（HbA1c）、C肽、空腹胰岛素（FINS）和胰高血糖素样肽-1（GLP-1）。对结果进行比较分析。
31例T2DM患者成功接受GBP手术（平均年龄46岁），男性14例，女性17例。其中7例患者患有高甘油三酯血症（HTG）。对患者进行6个月的随访。未发现重大并发症。术前平均BMI为26.5±1.4kg/m²。与术前相比，所有患者术后FPG、HbA1c、C肽、FINS的平均水平均有统计学意义的下降（P<0.05）。然而，与术前相比，所有患者术后GLP-1的均值有统计学意义的升高（P<0.05）。术后6个月，22例患者（71%）实现T2DM完全缓解，糖化血红蛋白<6.5%；7例患者（23%）实现T2DM部分缓解，6.5%≤糖化血红蛋白<7.0%；2例患者（6%）未实现T2DM缓解。与术前相比，31例患者术后血清甘油三酯的均值有统计学意义的下降（P<0.05）。
本研究表明，GBP手术对BMI<28kg/m²的T2DM患者安全有效，HTG患者的病情得到显著改善。然而，需要进一步开展大样本、长期随访的研究。
