Viscido German, Gorodner Veronica, Signorini Franco José, Biasoni A Carolina, Navarro Luciano, Rubin Graciela, Obeide Lucio, Moser Federico
1 General Surgery Department, Hospital Privado, Centro Médico de Córdoba, Córdoba, Argentina.
2 General Surgery Department, Clínica Universitaria Reina Fabiola, Córdoba, Argentina.
J Laparoendosc Adv Surg Tech A. 2019 May;29(5):655-662. doi: 10.1089/lap.2018.0652. Epub 2018 Nov 16.
Bariatric surgery is superior to medical treatment for type 2 diabetes mellitus (T2DM) control in obese patients. Reports in the literature have been mainly based on Roux-en-Y gastric bypass (RYGB) or adjustable gastric band. The aim of this study was to analyze mid- and long-term metabolic results after laparoscopic sleeve gastrectomy (LSG). Obese patients with T2DM undergoing LSG were included in this study. Selection criteria for T2DM remission were: post-operatory fasting glucose (FG) level <100 mg/dL, and hemoglobin A1c (HbA1c) <6% without medication. Between January 2009 and July 2016, 166 T2DM obese patients underwent LSG and completed ≥1 year follow-up. There were 101 women (60.8%; mean age 49.07 ± 12.8 years). Initial body mass index (BMI) was 46.44 ± 7.68 kg/m. Mean time since T2DM diagnosis was 5.95 years (1-28). Preoperative HbA1c was 7.53% ± 0.97%. Before LSG, 75.3% ( = 125) were receiving oral hypoglycemic agents, and 13.25% ( = 22) insulin. Mean follow-up was 65 ± 10 months. Complete T2DM remission was achieved in 78.3%, 76.2%, and 71.4% at 1, 3, and ≥5 years respectively; in the long term, 7.2% attained partial remission, 10% improved, and 11.4% experienced recurrence of the disease. Remission rate was significantly lower in patients under insulin therapy preoperatively, and in patients with T2DM diagnosed ≥5 years before consultation ( = .0004 and .0001, respectively). At mid- and long-term follow-up, T2DM control was satisfactory after LSG. Preoperative insulin therapy and T2DM duration ≥5 years were predictors of less favorable outcomes.
对于肥胖患者的2型糖尿病（T2DM）控制，减重手术优于药物治疗。文献报道主要基于Roux-en-Y胃旁路术（RYGB）或可调节胃束带术。本研究的目的是分析腹腔镜袖状胃切除术（LSG）后的中长期代谢结果。本研究纳入了接受LSG的T2DM肥胖患者。T2DM缓解的选择标准为：术后空腹血糖（FG）水平<100mg/dL，且糖化血红蛋白（HbA1c）<6%且无需药物治疗。2009年1月至2016年7月，166例T2DM肥胖患者接受了LSG并完成了≥1年的随访。其中有101名女性（60.8%；平均年龄49.07±12.8岁）。初始体重指数（BMI）为46.44±7.68kg/m²。自T2DM诊断以来的平均时间为5.95年（1 - 28年）。术前HbA1c为7.53%±0.97%。在LSG前，75.3%（n = 125）接受口服降糖药治疗，13.25%（n = 22）接受胰岛素治疗。平均随访时间为65±10个月。在1年、3年和≥5年时，T2DM完全缓解率分别为78.3%、76.2%和71.4%；从长期来看，7.2%达到部分缓解，10%病情改善，11.4%疾病复发。术前接受胰岛素治疗的患者以及在就诊前≥5年诊断为T2DM的患者缓解率显著较低（分别为P = 0.0004和P = 0.0001）。在中长期随访中，LSG后T2DM控制情况良好。术前胰岛素治疗和T2DM病程≥5年是预后较差的预测因素。
