Department of General Surgery, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
Department of General Surgery, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
Surg Obes Relat Dis. 2019 Sep;15(9):1513-1519. doi: 10.1016/j.soard.2019.03.027. Epub 2019 Mar 26.
Loop duodenojejunal bypass with sleeve gastrectomy (LDJB-SG) is a simplified biliopancreatic diversion with duodenal switch.
This study investigated the therapeutic outcomes of LDJB-SG and predictors of type 2 diabetes (T2D) remission in Chinese patients with a body mass index (BMI) of 20 to 32.5 kg/m.
A university hospital.
This retrospective study included 28 T2D patients with a BMI of 20 to 32.5 kg/m who underwent LDJB-SG. T2DM remission, weight loss, postoperative nutrition status, and complications at 1- and 3-year follow-up were assessed. Remission of T2DM was defined as a fasting blood glucose <7 mmol/L and HbA1C <6.5% for 1 year without pharmacological intervention.
At 1-year follow-up after LDJB-SG, the T2D remission rate was 75% (21/28), and the mean total weight loss was 23.6%. The 3-year T2D remission rate and percent of total weight loss were 68.4% (13/19) and 20.3%, respectively. Univariate and multivariate analysis indicated that duration of T2D was the only risk factor associated with T2D remission (P < .05). LDJB-SG improved the metabolic syndrome by increasing the high-density lipoprotein cholesterol level (P = .0157), decreasing waist circumference (P < .0001), and decreasing triglycerides (P = .0053). Postoperative complications of LDJB-SG included malodorous flatus (64.3%), accidental diarrhea induced by greasy food (57.1%), de novo gastroesophageal reflux disease (28.6%), anemia (25%), fatigue (21.4%), underweight (17.9%), intolerance to cooked rice (10.7%), constipation (7.1%), and steatorrhea (3.6%).
LDJB-SG resulted in acceptable T2D remission and metabolic improvement at 1- and 3-year follow-up in Chinese T2D patients with a BMI of 20 to 32.5 kg/m. T2D duration may serve as the predictor of T2D remission. LDJB-SG should be performed with caution because of the high incidence of postoperative complications.
Loop 十二指肠空肠旁路联合袖状胃切除术（LDJB-SG）是一种简化的胆胰分流联合十二指肠转位术。
本研究旨在探讨 LDJB-SG 对中国 20 至 32.5kg/m2 体重指数（BMI）的 2 型糖尿病（T2DM）患者的治疗效果及其对 T2DM 缓解的预测因素。
大学医院。
本回顾性研究纳入了 28 例 T2DM 患者，BMI 为 20 至 32.5kg/m2，均行 LDJB-SG 术。术后 1 年和 3 年随访时评估 T2DM 缓解情况、体重减轻情况、术后营养状况和并发症。T2DM 缓解定义为空腹血糖＜7mmol/L，HbA1C＜6.5%，且无需药物干预持续 1 年。
LDJB-SG 术后 1 年时，T2DM 缓解率为 75%（21/28），平均总减重 23.6%。3 年 T2DM 缓解率和总减重百分比分别为 68.4%（13/19）和 20.3%。单因素和多因素分析表明，T2DM 病程是与 T2DM 缓解相关的唯一危险因素（P＜0.05）。LDJB-SG 通过提高高密度脂蛋白胆固醇水平（P=0.0157）、降低腰围（P＜0.0001）和降低甘油三酯（P=0.0053）改善了代谢综合征。LDJB-SG 的术后并发症包括恶臭性呃逆（64.3%）、高脂饮食诱发的偶然腹泻（57.1%）、新发胃食管反流病（28.6%）、贫血（25%）、疲劳（21.4%）、体重过轻（17.9%）、不耐受米饭（10.7%）、便秘（7.1%）和脂肪泻（3.6%）。
对于中国 20 至 32.5kg/m2 体重指数的 T2DM 患者，LDJB-SG 在术后 1 年和 3 年均能获得可接受的 T2DM 缓解和代谢改善效果。T2DM 病程可能是 T2DM 缓解的预测因素。由于术后并发症发生率较高，LDJB-SG 应谨慎进行。
