Osland Emma, Yunus Rossita Mohamad, Khan Shahjahan, Memon Breda, Memon Muhammed Ashraf
Department of Nutrition and Dietetics, Royal Brisbane and Women's Hospital, Herston, QLD, 4019, Australia.
Department of Human Movements and Nutrition, University of Queensland, Brisbane, QLD, Australia.
Surg Endosc. 2017 Apr;31(4):1952-1963. doi: 10.1007/s00464-016-5202-5. Epub 2016 Sep 13.
The prevalence of type 2 diabetes is growing in both developed and developing countries and is strongly linked with the prevalence of obesity. Bariatric surgical procedures such as laparoscopic vertical sleeve gastrectomy (LVSG) and laparoscopic Roux-en-Y gastric bypass (LRYGB) are increasingly being utilized to manage related comorbid chronic conditions, including type 2 diabetes.
A systematic review of randomized controlled trials (RCTs) was undertaken using the PRISMA guidelines to investigate the postoperative impact on diabetes resolution following LVSG versus LRYGB.
Seven RCTs involving a total of 732 patients (LVSG n = 365, LRYGB n = 367) met inclusion criteria. Significant diabetes resolution or improvement was reported with both procedures across all time points. Similarly, measures of glycemic control (HbA1C and fasting blood glucose levels) improved with both procedures, with earlier improvements noted in LRYGB that stabilized and did not differ from LVSG at 12 months postoperatively. Early improvements in measures of insulin resistance in both procedures were also noted in the studies that investigated this.
This systematic review of RCTs suggests that both LVSG and LRYGB are effective in resolving or improving preoperative type 2 diabetes in obese patients during the reported 3- to 5-year follow-up periods. However, further studies are required before longer-term outcomes can be elucidated. Areas identified that need to be addressed for future studies on this topic include longer follow-up periods, standardized definitions and time point for reporting, and financial analysis of outcomes obtained between surgical procedures to better inform procedure selection.
2型糖尿病在发达国家和发展中国家的患病率均呈上升趋势，且与肥胖患病率密切相关。诸如腹腔镜垂直袖状胃切除术（LVSG）和腹腔镜Roux-en-Y胃旁路术（LRYGB）等减肥手术越来越多地被用于治疗包括2型糖尿病在内的相关合并慢性病。
采用PRISMA指南对随机对照试验（RCT）进行系统评价，以研究LVSG与LRYGB术后对糖尿病缓解的影响。
7项RCT共纳入732例患者（LVSG组365例，LRYGB组367例）符合纳入标准。在所有时间点，两种手术均报告有显著的糖尿病缓解或改善。同样，两种手术的血糖控制指标（糖化血红蛋白和空腹血糖水平）均有所改善，LRYGB在术后12个月时改善较早且趋于稳定，与LVSG无差异。在相关研究中还发现，两种手术的胰岛素抵抗指标均有早期改善。
这项对RCT的系统评价表明，在报告的3至5年随访期内，LVSG和LRYGB在解决或改善肥胖患者术前2型糖尿病方面均有效。然而，在阐明长期结果之前还需要进一步研究。该主题未来研究需要解决的领域包括更长的随访期、报告的标准化定义和时间点，以及对手术之间获得的结果进行财务分析，以便更好地为手术选择提供参考。
