Seki Yosuke, Kasama Kazunori, Haruta Hidenori, Watanabe Atsushi, Yokoyama Renzo, Porciuncula Jose Paolo Cabreira, Umezawa Akiko, Kurokawa Yoshimochi
Weight Loss and Metabolic Surgery Center, Yotsuya Medical Cube, 7-7 Nibancho, Chiyoda-ku, Tokyo, 102-0084, Japan.
Center for Clinical Research, Okinawa Prefectural Chubu Hospital, Okinawa, Japan.
Obes Surg. 2017 Mar;27(3):795-801. doi: 10.1007/s11695-016-2372-0.
Laparoscopic sleeve gastrectomy with duodenojejunal bypass (LSG-DJB) has been designated as a novel bariatric surgery procedure. This combination of sleeve gastrectomy and proximal intestinal bypass theoretically offers an effective and prolonged anti-diabetes effect. This is a follow-up of our institution's previous report on the short-term effects of LSG-DJB on type 2 diabetes mellitus (T2DM), which a 68.7 % remission (HbA1c <6 % without diabetes medication) rate 1 year after surgery. The aforementioned result was comparable to the reported remission rates of laparoscopic Roux-en-Y gastric bypass. However, the durability of remission remains unknown.
The objective of this study is to investigate the medium-term (up to 5 years) effects of LSG-DJB on weight loss and T2DM.
In this analysis, consecutive 120 patients (female to male ratio = 61:59, mean age = 44.8 years) with T2DM who underwent LSG-DJB from April 2007 to November 2013 and were followed up beyond 1 year were included. The preoperative mean body weight and BMI were 105.7 kg and 38.5 kg/m, respectively. The mean HbA1c and fasting blood glucose values were 8.9 % and 194 mg/dL, respectively. The mean duration of T2DM was 7.3 years. Fifty-five patients (46 %) were being treated with insulin prior to surgery.
The follow-up rate was 97.5 % at 1 year, 73.3 % at 3 years, and 50.0 % at 5 years. The mean body weight was 74.9 kg at 1 year, 76.8 kg at 3 years, and 72.8 kg at 5 years (p < 0.001, compared to the baseline). The mean percent of total body weight loss (%TWL) was 28.9, 28.6, and 30.7 % at 1, 3, and 5 years, respectively. Remission of T2DM was achieved at 63.6, 55.3, and 63.6 % at 1, 3, and 5 years, respectively. Among those who achieved diabetes remission at 1 year, 10.8 % of them experienced recurrence during the subsequent follow-up period.
Although recurrence of T2DM is observed in some patients over time, LSG-DJB is an effective procedure for achieving significant weight loss and improvement of glycemic control, and the effects seem to be durable up to 5 years.
腹腔镜袖状胃切除术联合十二指肠空肠旁路术（LSG-DJB）已被认定为一种新型减肥手术。袖状胃切除术和近端肠道旁路术的这种联合理论上可提供有效且持久的抗糖尿病效果。这是对我们机构先前关于LSG-DJB对2型糖尿病（T2DM）短期影响报告的随访，报告显示术后1年缓解率（糖化血红蛋白<6%且无需糖尿病药物治疗）为68.7%。上述结果与腹腔镜Roux-en-Y胃旁路术报告的缓解率相当。然而，缓解的持久性尚不清楚。
本研究的目的是调查LSG-DJB对体重减轻和T2DM的中期（长达5年）影响。
在本分析中，纳入了2007年4月至2013年11月期间连续接受LSG-DJB且随访超过1年的120例T2DM患者（女性与男性比例为61:59，平均年龄44.8岁）。术前平均体重和体重指数分别为105.7kg和38.5kg/m²。平均糖化血红蛋白和空腹血糖值分别为8.9%和194mg/dL。T2DM的平均病程为7.3年。55例患者（46%）术前接受胰岛素治疗。
1年随访率为97.5%，3年为73.3%，5年为50.0%。1年时平均体重为74.9kg，3年时为76.8kg，5年时为72.8kg（与基线相比，p<0.001）。1年、3年和5年时总体重减轻百分比（%TWL）分别为28.9%、28.6%和30.7%。1年、3年和5年时T2DM的缓解率分别为63.6%、55.3%和63.6%。在1年时实现糖尿病缓解的患者中，10.8%在随后的随访期间复发。
尽管随着时间推移在一些患者中观察到T2DM复发，但LSG-DJB是实现显著体重减轻和改善血糖控制的有效手术，且这种效果似乎可持续长达5年。
