Department of Laboratory Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510120, China.
Department of General Surgery, Guangzhou Red Cross Hospital, Medical College, Jinan University, Guangzhou, 510220, China.
Obes Surg. 2020 May;30(5):1660-1670. doi: 10.1007/s11695-019-04378-2.
Recently, randomized controlled trials (RCTs) have indicated that bariatric surgery in nonseverely obese patients with a body mass index (BMI) less than 35 kg/m might be even superior to medical therapy with regard to type 2 diabetes mellitus (T2DM) remission, but the efficacy of laparoscopic Roux-en-Y gastric bypass (LRYGB) compared with laparoscopic sleeve gastrectomy (LSG) in nonseverely obese patients has not been conclusively determined. The objective of this study is to compare LRYGB versus LSG for T2DM in nonseverely obese patients.
A meta-analysis identifying RCTs evaluating LRYGB versus LSG for T2DM in nonseverely obese patients was conducted. The primary outcome was T2DM remission. Additional analyses comprised percent excess weight loss (%EWL), BMI, waist circumference, hemoglobin A1c (HbA1c), fasting plasma glucose (FPG), serum lipid level, medication use, quality of life, and adverse events.
Four RCTs concerning total 296 patients were included. T2DM remission rate and %EWL were of no difference between the two bariatric procedures. LRYGB was associated with lower BMI, waist circumference, low-density lipoprotein, and higher high-density lipoprotein than LSG. However, HbA1c, FPG, total cholesterol, and triglyceride were not significantly different between the two surgical groups. The medication use and quality of life were improved in both two groups. The gastroesophageal reflux diseases of LRYGB group were less than that of LSG group. Dumping syndromes were noted more frequently in the LRYGB group.
Both LRYGB and LSG have comparative effect on resolving T2DM in nonseverely obese patients at midterm follow-up. Further RCTs should address the potential risks and long-term effects of LRYGB and LSG in nonseverely obese patients.
最近，随机对照试验（RCT）表明，对于 BMI 低于 35kg/m2 的非重度肥胖患者，减重手术在 2 型糖尿病（T2DM）缓解方面可能甚至优于药物治疗，但腹腔镜 Roux-en-Y 胃旁路术（LRYGB）与腹腔镜袖状胃切除术（LSG）在非重度肥胖患者中的疗效尚未确定。本研究的目的是比较 LRYGB 与 LSG 在非重度肥胖患者中的 T2DM 疗效。
进行了一项荟萃分析，以确定评估 LRYGB 与 LSG 治疗非重度肥胖患者 T2DM 的 RCT。主要结局是 T2DM 缓解。额外的分析包括 T2DM 缓解率、超重减轻百分比（%EWL）、BMI、腰围、糖化血红蛋白（HbA1c）、空腹血糖（FPG）、血清脂质水平、药物使用、生活质量和不良事件。
共纳入 4 项 RCT，总计 296 例患者。两种减重手术在 T2DM 缓解率和 %EWL 方面无差异。LRYGB 与 LSG 相比，BMI、腰围、低密度脂蛋白和高密度脂蛋白更高，但 HbA1c、FPG、总胆固醇和甘油三酯在两组之间无显著差异。两组患者的药物使用和生活质量均得到改善。LRYGB 组的胃食管反流病少于 LSG 组。LRYGB 组更常发生倾倒综合征。
在中期随访中，LRYGB 和 LSG 对解决非重度肥胖患者的 T2DM 具有相当的效果。进一步的 RCT 应该解决 LRYGB 和 LSG 在非重度肥胖患者中的潜在风险和长期影响。
