Murad Abdon José, Cohen Ricardo Vitor, de Godoy Eudes Paiva, Scheibe Christian Lamar, Campelo Giuliano Peixoto, Ramos Almino Cardoso, de Lima Roclides Castro, Pinto Luís Eduardo Veras, Coelho Daniel, Costa Hamilton Belo França, Pinto Ígor Marreiros Pereira, Pereira Tiago, Teófilo Francisco Raúl Santos, Valadão José Aparecido
Center for Bariatric and Metabolic Surgery, São Domingos Hospital, São Luís, Brazil.
The Center for Obesity and Diabetes, Oswaldo Cruz German Hospital, São Paulo, Brazil.
Obes Surg. 2018 Mar;28(3):599-605. doi: 10.1007/s11695-017-2933-x.
Type-2 diabetes (T2D) patients with body mass index (BMI) below 35 kg/m carry lower remission rates than severely obese T2D individuals submitted to "standard limb lengths" Roux-en-Y gastric bypass (RYGB). Mild-obese patients appear to have more severe forms of T2D, where the mechanisms of glycemic control after a standard-RYGB may be insufficient. The elongation of the biliopancreatic limb may lead to greater stimulation of the distal intestine, alterations in bile acids and intestinal microbiota, among other mechanisms, leading to better metabolic outcomes. The aim of this study is to evaluate the safety and efficacy of the RYGB with a biliopancreatic limb of 200 cm in the control of T2D in patients with BMI 30-35 kg/m.
From January 2011 to May 2015, 102 T2D patients with BMI from 30 to 34.9 kg/m underwent laparoscopic RYGB with the biliopancreatic-limb of 200 cm and the alimentary-limb of 50 cm.
There were no deaths or reoperations. The mean follow-up was 28.1 months. The mean BMI dropped from 32.5 to 25.1 kg/m, while the mean fasting glucose decreased from 182.9 to 89.8 mg/dl and the mean glycated hemoglobin (HbA1c) went from 8.7 to 5.2%. During follow-up, 92.2% had their T2D under complete control (HbA1c < 6%, no anti-diabetic medications), while 7.8% were under partial control. Control of hypertension and dyslipidemia were 89.4 and 85.5%, respectively. No patient developed hypoalbuminemia, and there were mild micronutrient deficiencies.
RYGB with long-biliopancreatic and short-alimentary limbs is safe and seems effective in achieving complete control of T2D in patients with BMIs between 30 and 35 kg/m.
体重指数（BMI）低于35kg/m²的2型糖尿病（T2D）患者的缓解率低于接受“标准肠袢长度” Roux-en-Y胃旁路术（RYGB）的重度肥胖T2D患者。轻度肥胖患者的T2D形式似乎更为严重，标准RYGB术后血糖控制机制可能并不充分。胆胰袢延长可能会导致对远端肠道的更大刺激、胆汁酸和肠道微生物群的改变等，从而带来更好的代谢结果。本研究的目的是评估胆胰袢为200cm的RYGB在控制BMI为30-35kg/m²的患者T2D方面的安全性和有效性。
2011年1月至2015年5月，102例BMI为30至34.9kg/m²的T2D患者接受了腹腔镜下胆胰袢为200cm、 alimentary袢为50cm的RYGB手术。
无死亡或再次手术情况。平均随访时间为28.1个月。平均BMI从32.5降至25.1kg/m²，平均空腹血糖从182.9降至89.8mg/dl，平均糖化血红蛋白（HbA1c）从8.7降至5.2%。随访期间，92.2%的患者T2D得到完全控制（HbA1c < 6%，无需抗糖尿病药物），而7.8%为部分控制。高血压和血脂异常的控制率分别为89.4%和85.5%。无患者发生低蛋白血症，仅有轻度微量营养素缺乏。
胆胰袢长、 alimentary袢短的RYGB在实现BMI为30至35kg/m²患者的T2D完全控制方面是安全且有效的。
