Nora Mário, Morais Tiago, Almeida Rui, Guimarães Marta, Monteiro Mariana P
Department of General Surgery, Centro Hospitalar de Entre o Douro e Vouga, Santa Maria da Feira Clinical and Experimental Endocrinology, Multidisciplinary Unit for Biomedical Research (UMIB), ICBAS, University of Porto Anatomy Department, Instituto Ciencias Biomédicas Abel Salazar (ICBAS), Universidade do Porto, Porto, Portugal.
Medicine (Baltimore). 2017 Dec;96(48):e8859. doi: 10.1097/MD.0000000000008859.
The objective is to access the role of Roux-en-Y gastric bypass (RYGB) biliopancreatic limb (BPL) length in type 2 diabetes (T2D) outcomes.RYGB is more effective than medical intervention for T2D treatment in obese patients. Despite the scarcity of available data, previous reports suggest that modifications of the RYGB limb lengths could improve the antidiabetic effects of the surgery.A cohort of obese T2D patients (n = 114) were submitted to laparoscopic RYGB, either with a standard BPL (SBPL) (n = 41; BPL 84 ± 2 cm) or long BPL (LBPL) (n = 73; BPL = 200 cm) and routinely monitored for weight loss and diabetic status up to 5 years after surgery.Baseline clinical features in the 2 patient subgroups were similar. After surgery, there was a significant reduction of body mass index (BMI) in both the groups, although the percentage of excess BMI loss (%EBMIL) after 5 years was higher for LBPL (75.50 ± 2.63 LBPL vs 65.90 ± 3.61 SBPL, P = .04). T2D remission rate was also higher (73% vs 55%, P < .05), while disease relapse rate (13.0% vs 32.5%; P < .05) and antidiabetic drug requirement in patients with persistent diabetes were lower after LBPL. Preoperative T2D duration predicted disease remission, but only for SBPL.RYGB with a longer BPL improves %EBMIL, T2D remission, and glycemic control in those with persistent disease, while it decreases diabetes relapse rate over time. The antidiabetic effects of LBPL RYGB also are less influenced by the preoperative disease duration. These data suggest the RYGB procedure could be tailored to improve T2D outcomes.
目的是探讨Roux-en-Y胃旁路术（RYGB）的胆胰支（BPL）长度在2型糖尿病（T2D）治疗效果中的作用。对于肥胖患者的T2D治疗，RYGB比药物干预更有效。尽管可用数据稀缺，但先前的报告表明，改变RYGB的肢体长度可能会改善手术的抗糖尿病效果。一组肥胖T2D患者（n = 114）接受了腹腔镜RYGB手术，其中标准BPL（SBPL）组（n = 41；BPL 84±2 cm）或长BPL（LBPL）组（n = 73；BPL = 200 cm），并在术后长达5年的时间里对体重减轻和糖尿病状态进行常规监测。两个患者亚组的基线临床特征相似。术后，两组的体重指数（BMI）均显著降低，尽管5年后LBPL组的超重BMI损失百分比（%EBMIL）更高（LBPL组为75.50±2.63，SBPL组为65.90±3.61，P = 0.04）。LBPL组的T2D缓解率也更高（73%对55%，P < 0.05），而疾病复发率（13.0%对32.5%；P < 0.05）以及持续糖尿病患者的抗糖尿病药物需求在LBPL组更低。术前T2D病程可预测疾病缓解，但仅适用于SBPL组。BPL较长的RYGB可提高%EBMIL、T2D缓解率以及持续性疾病患者的血糖控制，同时随着时间推移降低糖尿病复发率。LBPL RYGB的抗糖尿病效果也较少受术前病程的影响。这些数据表明，RYGB手术可进行调整以改善T2D治疗效果。
