Guo Yulin, Xu Xiao, Wu Anjian, Du Jin, Dong Guanglong
Department of General Surgery, Chinese PLA General Hospital, Beijing 100853, China.
Department of Endocrinology, Chinese PLA General Hospital, Beijing 100853, China.
Zhonghua Wei Chang Wai Ke Za Zhi. 2017 Apr 25;20(4):400-404.
To evaluate the effect of laparoscopic sleeve gastrectomy(LSG) on type 2 diabetes mellitus (T2DM) in patient with a body mass index(BMI) less than 40 kg/m.
Twenty four obese patients with T2DM and BMI less than 40 kg/m received LSG between 1 January 2011 and 1 September 2013 at the Department of General Surgery in Chinese PLA General Hospital. The clinical data and 3-year follow-up outcomes regarding weight loss and remission of diabetes were retrospectively analyzed.
There were 10 males and 14 females with a median age of 40.8(35 to 48) years. The preoperative body weight and BMI was(99.9±15.0) kg and (34.4±2.8) kg/m, respectively. The median duration of type 2 diabetes was 4.3(2 to 15) years. The preoperative fasting blood glucose and glycosylated hemoglobin(HbAlc) was (11.4±1.3) mmol/L and (8.7±0.8)%, respectively. All these patients were preoperatively diagnosed as T2DM by the multidisciplinary experts of the surgical treatment team for obesity and diabetes in our center. All these patients were eligible for surgical treatment through the screening and evaluation by the multidisciplinary joint outpatient service. All the procedures were successfully completed without conversion to laparotomy. There were no severe postoperative complications. The mean fasting blood glucose was (6.4±1.8) mmol/L, (6.1±1.7) mmol/L, (6.0±1.5) mmol/L, (5.9±1.4) mmol/L and (6.0±1.4) mmol/L, respectively, at 6, 9, 12, 24 and 36 months after operation. The mean HbA1c in the same observation intervals was (6.6±1.1)%, (6.2±1.2)%, (6.1±1.2)%, (6.0±1.3)% and (6.1±1.3)%, respectively. The body weight was (89.4±11.4) kg, (86.3±10.6) kg, (83.1±10.2) kg,(80.6±9.8) kg and (81.3±10.1) kg, respectively. The corresponding BMI was (30.8±1.6) kg/m, (29.8±1.5) kg/m, (28.7±1.5) kg/m, (27.8±1.8) kg/m and (28.1±1.8) kg/m, respectively. The %EWL was (36.7±8.7)%, (47.6±12.5)%, (58.8±16.4)%, (67.2±20.3)% and (64.8±21.5)%, respectively. The overall remission rate of diabetes at 6, 9, 12, 24 and 36 months was 50.0%(12/24), 79.2%(19/24), 70.8%(17/24), 66.7%(16/24) and 62.5%(15/24), respectively. The complete remission rate was 33.3%(8/24), 50.0%(12/24), 54.2%(13/24), 45.8%(11/24) and 50.0%(12/24), respectively. For patients with a duration of T2DM shorter than 5 years, the overall remission rate at 9, 12 and 24 months after operation was 10/10, 9/10 and 9/10, respectively, significantly higher than that of patients with a duration of 11-15 years (2/6, 2/6 and 2/6, Fisher's exact tests, P=0.008, 0.036 and 0.036, respectively).
The present study confirms the efficacy of LSG in the treatment of T2DM patients with a BMI less than 40 kg/m.
评估腹腔镜袖状胃切除术（LSG）对体重指数（BMI）小于40kg/m²的2型糖尿病（T2DM）患者的疗效。
2011年1月1日至2013年9月1日期间，在中国人民解放军总医院普通外科，24例BMI小于40kg/m²的肥胖T2DM患者接受了LSG。对患者的临床资料以及3年随访期内体重减轻和糖尿病缓解情况进行回顾性分析。
患者中男性10例，女性14例，中位年龄40.8（35至48）岁。术前体重和BMI分别为（99.9±15.0）kg和（34.4±2.8）kg/m²。2型糖尿病的中位病程为4.3（2至15）年。术前空腹血糖和糖化血红蛋白（HbAlc）分别为（11.4±1.3）mmol/L和（8.7±0.8）%。所有患者术前均经本中心肥胖与糖尿病外科治疗团队的多学科专家诊断为T2DM。所有患者均通过多学科联合门诊的筛查和评估，符合手术治疗条件。所有手术均顺利完成，未中转开腹。术后无严重并发症。术后6、9、12、24和36个月时，平均空腹血糖分别为（6.4±1.8）mmol/L、（6.1±1.7）mmol/L、（6.0±1.5）mmol/L、（5.9±1.4）mmol/L和（6.0±1.4）mmol/L。同一观察期内的平均HbA1c分别为（6.6±1.1）%、（6.2±1.2）%、（6.1±1.2）%、（6.0±1.3）%和（6.1±1.3）%。体重分别为（89.4±11.4）kg、（86.3±10.6）kg、（83.1±10.2）kg、（80.6±9.8）kg和（81.3±10.1）kg。相应的BMI分别为（30.8±1.6）kg/m²、（29.8±1.5）kg/m²、（28.7±1.5）kg/m²、（27.8±1.8）kg/m²和（28.1±1.8）kg/m²。%EWL分别为（36.7±8.7）%、（47.6±12.5）%、（58.8±16.4）%、（67.2±20.3）%和（64.8±21.5）%。术后6、9、12、24和36个月时糖尿病的总体缓解率分别为50.0%（12/24）、79.2%（19/24）、70.8%（17/24）、66.7%（16/24）和62.5%（15/24）。完全缓解率分别为33.3%（8/24）、50.0%（12/24）、54.2%（13/24）以及45.8%（11/24）和50.0%（12/24）。对于T2DM病程短于5年的患者，术后9、12和24个月时的总体缓解率分别为10/10、9/10和9/10，显著高于病程为11 - 15年的患者（2/6、2/6和2/6，Fisher精确检验，P值分别为0.008、0.036和0.036）。
本研究证实了LSG治疗BMI小于40kg/m²的T2DM患者的疗效。
