Nedelcu Marius, Loureiro Marcelo, Skalli Mehdi, Galtier Florence, Jaussent Audrey, Deloze Melanie, Gagner Michel, Fabre Jean Michel, Nocca David
Centre Hospitalier Universitaire Montpellier, Montpellier, France; Université de Montpellier 1, Montpellier, France; Centre Chirurgical de l'Obesite, Clinique Saint Michel, Toulon, France.
Centre Hospitalier Universitaire Montpellier, Montpellier, France; Université de Montpellier 1, Montpellier, France; Universidade Positivo, Curitiba, Brazil.
Surgery. 2017 Oct;162(4):857-862. doi: 10.1016/j.surg.2017.02.018. Epub 2017 Jul 22.
In the short-term, laparoscopic sleeve gastrectomy has been shown to be effective for the treatment of the type 2 diabetes in patients with severe obesity. There are few data with greater follow-up. Our aim was to evaluate the results of laparoscopic sleeve gastrectomy on the control of type 2 diabetes in patients with severe obesity at 5 years at the University Hospital, France.
From a total of 355 patients with severe obesity operated between January 2006 and June 2010, 52 (15%) had a diagnosis of type 2 diabetes before undergoing laparoscopic sleeve gastrectomy.
There were 31 females (60%) and 21 males (40%), with a mean age of 51 ± 10 years (range 27-67) with a mean body mass index of 48 ± 10 kg/m (range 35-82). The mean duration of type 2 diabetes was 10.8 ± 10.8 years before bariatric operation. The preoperative glycated hemoglobin was 8 ± 2% (range 5.9-12.8) in 45 patients; 17 patients (38%) had levels of glycated hemoglobin ≥9%. Three patients (6%) required insulin alone, 4 (8%) were taking oral antidiabetic medicine and insulin, and the remaining 45 patients (87%) were taking only oral antidiabetic medicines. The complete data regarding weight loss at 5-year follow-up were obtained for 46 patients, yielding an overall follow-up rate of 89%. The prolonged remission of type 2 diabetes achieved at 1 year that persisted at 5 years of follow-up was present in 9 patients (17%). No patient with complete remission of their type 2 diabetes required insulin preoperatively. Improvement of type 2 diabetes was observed in 30 patients (58%) at 1 year, which was maintained for 27 patients (52%) at 5-year follow-up.
Laparoscopic sleeve gastrectomy has demonstrated a moderate efficacy in the treatment morbidly obese patients with type 2 diabetes. Markedly increased preoperative glycated hemoglobin levels, older age, and preoperative need for insulin treatment may be the factors predicting failure of complete remission of type 2 diabetes after laparoscopic sleeve gastrectomy.
短期内，腹腔镜袖状胃切除术已被证明对重度肥胖患者的2型糖尿病治疗有效。长期随访的数据较少。我们的目的是评估法国大学医院腹腔镜袖状胃切除术对重度肥胖患者5年2型糖尿病控制的效果。
在2006年1月至2010年6月间接受手术的355例重度肥胖患者中，52例（15%）在接受腹腔镜袖状胃切除术之前被诊断为2型糖尿病。
有31名女性（60%）和21名男性（40%），平均年龄为51±10岁（范围27 - 67岁），平均体重指数为48±10kg/m²（范围35 - 82）。在减肥手术前，2型糖尿病的平均病程为10.8±10.8年。45例患者术前糖化血红蛋白为8±2%（范围5.9 - 12.8）；17例患者（38%）糖化血红蛋白水平≥9%。3例患者（6%）仅需胰岛素治疗，4例（8%）同时服用口服降糖药和胰岛素，其余45例患者（87%）仅服用口服降糖药。46例患者获得了5年随访时体重减轻的完整数据，总随访率为89%。9例患者（17%）在1年时实现了2型糖尿病的长期缓解，并在5年随访时持续存在。术前没有2型糖尿病完全缓解的患者需要胰岛素治疗。1年时30例患者（58%）的2型糖尿病有所改善，5年随访时27例患者（52%）仍保持改善。
腹腔镜袖状胃切除术在治疗重度肥胖的2型糖尿病患者中显示出中等疗效。术前糖化血红蛋白水平显著升高、年龄较大以及术前需要胰岛素治疗可能是预测腹腔镜袖状胃切除术后2型糖尿病完全缓解失败的因素。
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