Aminian Ali, Andalib Amin, Khorgami Zhamak, Kashyap Sangeeta R, Burguera Bartolome, Schauer Philip R, Brethauer Stacy A
Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, Ohio.
Center for Bariatric Surgery, Department of Surgery, McGill University, Montreal, Quebec, Canada.
Surg Obes Relat Dis. 2016 Jul;12(6):1163-70. doi: 10.1016/j.soard.2016.05.007. Epub 2016 May 11.
Bariatric surgery is more effective than medical therapy in treatment of type 2 diabetes (T2D) in patients with severe obesity. However, surgery is often not advocated for patients with T2D who are overweight or have mild obesity.
To assess the safety profile of bariatric surgery in patients with T2D and mild obesity.
Database of the American College of Surgeons-National Surgical Quality Improvement Program.
Data of 1300 patients with T2D and a body mass index≥25 but<35 kg/m(2) who underwent bariatric surgery were retrieved from the American College of Surgeons-National Surgical Quality Improvement Program data set (2005-2014) to assess safety profile. Further stratified analyses were carried out between Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG).
The mean operative time and length of hospital stay were 109.4±58.3 minutes and 1.9±1.5 days, respectively. Incidence of all individual major complications was≤.5% in this cohort except for postoperative bleeding (1.7%). Thirty-day postoperative composite morbidity, serious morbidity, and mortality rates for total cohort were 4.2%, .7%, and .15%, respectively. Smoking (odds ratio = 2.75, 95% confidence interval: 1.34-5.64) and chronic obstructive pulmonary disease (odds ratio = 4.05, 95% confidence interval: 1.51-10.88) were predictors of composite morbidity. Thirty-day morbidity rates were not significantly different between those who underwent RYGB compared with SG.
Bariatric surgery, which is a 2-hour procedure requiring a 2-day hospital stay, is a relatively well-tolerated option in patients with T2D and mild obesity. RYGB and SG had comparable early postoperative morbidity. Smoking can be considered as a modifiable risk factor for early complications after bariatric surgery in patients with T2D and lower body mass index.
在治疗重度肥胖的2型糖尿病（T2D）患者时，减肥手术比药物治疗更有效。然而，对于超重或轻度肥胖的T2D患者，通常不提倡进行手术。
评估减肥手术在T2D和轻度肥胖患者中的安全性。
美国外科医师学会-国家外科质量改进计划数据库。
从美国外科医师学会-国家外科质量改进计划数据集（2005 - 2014年）中检索1300例T2D且体重指数≥25但<35 kg/m²并接受减肥手术的患者数据，以评估安全性。对 Roux-en-Y胃旁路术（RYGB）和袖状胃切除术（SG）进行了进一步的分层分析。
平均手术时间和住院时间分别为109.4±58.3分钟和1.9±1.5天。除术后出血（1.7%）外，该队列中所有个体主要并发症的发生率均≤.5%。整个队列术后30天的综合发病率、严重发病率和死亡率分别为4.2%、.7%和.15%。吸烟（比值比 = 2.75，95%置信区间：1.34 - 5.64）和慢性阻塞性肺疾病（比值比 = 4.05，95%置信区间：1.51 - 10.88）是综合发病率的预测因素。接受RYGB的患者与接受SG的患者相比，30天发病率无显著差异。
减肥手术是一个需要2天住院时间的2小时手术，在T2D和轻度肥胖患者中是一种耐受性相对较好的选择。RYGB和SG术后早期发病率相当。吸烟可被视为T2D和较低体重指数患者减肥手术后早期并发症的一个可改变的风险因素。
