Du Xiao, Fu Xiang-Hui, Shi Lei, Hu Jian-Kun, Zhou Zong-Guang, Cheng Zhong
Department of Gastrointestinal Surgery, Laboratory of Bariatric and Metabolic Surgery, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, 610041, People's Republic of China.
Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, 610041, People's Republic of China.
Obes Surg. 2018 Mar;28(3):702-711. doi: 10.1007/s11695-017-2903-3.
Laparoscopic Roux-en-Y gastric bypass (LRYGB) has been proven to be effective on treating type 2 diabetes mellitus (T2DM) in severely obese patients, but whether LRYGB surgery should be performed in obese class I patients is controversial.
A retrospective study of 3-year bariatric and metabolic outcomes in different obese class T2DM patients who underwent LRYGB was conducted to compare the effectiveness of LRYGB in obese class I patients with that in obese class II/III patients in a Chinese T2DM population.
Totally, 58 patients with class I obesity and 45 patients with class II/III obesity were enrolled in this study. Major complications included two cases of incomplete intestinal obstructions and one anastomotic leak. The remission rates of T2DM were 70.6% in obese class I group and 77.8% in obese class II/III group at 1 year after surgery and 55.6 versus 64.3% at 3 years (all P > 0.05). Logistic regression analysis showed that higher waist circumference, lower fasting plasma glucose, and higher FCP at 2 h of OGTT were independently associated with diabetes remission at 1 year after surgery. At 1 year and thereafter, the percentage of excess weight loss was significantly greater in obese class II/III patients. At 3 years, body mass index was not significantly different between the two groups, and the obese class I patients had high recurrence rates of hypertension and hyperuricemia.
LRYGB surgery is feasible, safe, and effective in Chinese obese class I patients with T2DM.
腹腔镜Roux-en-Y胃旁路术（LRYGB）已被证明对治疗重度肥胖患者的2型糖尿病（T2DM）有效，但LRYGB手术是否应在I级肥胖患者中进行仍存在争议。
对接受LRYGB手术的不同肥胖等级的T2DM患者进行了为期3年的减重和代谢结局的回顾性研究，以比较LRYGB在中国T2DM人群中I级肥胖患者与II/III级肥胖患者的有效性。
本研究共纳入58例I级肥胖患者和45例II/III级肥胖患者。主要并发症包括2例不完全性肠梗阻和1例吻合口漏。术后1年，I级肥胖组T2DM缓解率为70.6%，II/III级肥胖组为77.8%；术后3年分别为55.6%和64.3%（均P>0.05）。Logistic回归分析显示，较高的腰围、较低的空腹血糖以及口服葡萄糖耐量试验2小时时较高的空腹C肽水平与术后1年糖尿病缓解独立相关。术后1年及以后，II/III级肥胖患者的超重减轻百分比显著更高。3年后，两组间体重指数无显著差异，I级肥胖患者高血压和高尿酸血症复发率较高。
LRYGB手术在中国I级肥胖T2DM患者中可行、安全且有效。
