Ke Zhigang, Li Fan, Gao Yu, Zhou Xunmei, Sun Fang, Wang Li, Chen Jing, Tan Xin, Zhu Zhiming, Tong Weidong
Department of General Surgery, Daping Hospital, Army Medical University, Chongqing, China.
Department of Hypertension and Endocrinology, Daping Hospital, Army Medical University, Center for Hypertension and Metabolic Diseases, Chongqing Institute of Hypertension, Chongqing, China.
Wideochir Inne Tech Maloinwazyjne. 2021 Mar;16(1):129-138. doi: 10.5114/wiitm.2020.99997. Epub 2020 Oct 14.
Although laparoscopic Roux-en-Y gastric bypass (RYGB) is still widely accepted as a valid procedure in the treatment of obesity and type 2 diabetes mellitus (T2DM), there continues to be a significant controversy about how long the Roux and biliopancreatic limb should be bypassed for optimum results.
To assess the effect of a longer biliopancreatic limb (BPL) length on glycemic control after RYGB in T2DM patients.
Eighty-four patients with uncontrolled T2DM who underwent RYGB between May 2010 and April 2017 were collected from the prospectively designed database. Forty patients (S-BPL group) received BPL lengths ≤ 50 cm, including 30 cm (n = 1), 40 cm (n = 1), and 50 cm (n = 38). Forty-four patients (L-BPL group) received 100 cm BPL. Anthropometry, serum glucose and lipid metabolic parameters were measured at baseline and 1, 3, 6, 12, 24 and 36 months after surgery.
Comparing the two groups, there were no significant differences in anthropometric and biochemical measures, except the weight and body mass index, which were higher in the S-BPL group (85.91 ±20.32 vs. 76.25 ±16.99, p = 0.038; 31.87 ±6.61 vs. 28.7 ±4.29, p = 0.005) compared to the L-BPL group. The body weight, glucose and lipid metabolic parameters decreased over time and then remained essentially stable from the first year in both groups. Two years after surgery, the remission (HbA% ≤ 6%) of T2DM was 31.2% in the S-BPL group and 37.5% in the L-BPL group (p = 0.685).
With consistent total small bowel bypass (AL + BPL) lengths, lengthening of the BPL from 30 to 100 cm did not affect the post-RYGB glycemic control and weight loss.
尽管腹腔镜Roux-en-Y胃旁路术（RYGB）在肥胖症和2型糖尿病（T2DM）治疗中仍被广泛认为是一种有效的手术方法，但对于Roux袢和胆胰支应旷置多长时间才能达到最佳效果，仍存在重大争议。
评估延长胆胰支（BPL）长度对T2DM患者RYGB术后血糖控制的影响。
从前瞻性设计的数据库中收集2010年5月至2017年4月期间接受RYGB手术的84例T2DM控制不佳患者。40例患者（短BPL组）接受的BPL长度≤50 cm，包括30 cm（n = 1）、40 cm（n = 1）和50 cm（n = 38）。44例患者（长BPL组）接受100 cm的BPL。在基线以及术后1、3、6、12、24和36个月测量人体测量学指标、血清葡萄糖和脂质代谢参数。
两组比较，除体重和体重指数外，人体测量学和生化指标无显著差异，短BPL组的体重和体重指数高于长BPL组（85.91±20.32 vs. 76.25±16.99，p = 0.038；31.87±6.61 vs. 28.7±4.29，p = 0.005）。两组的体重、血糖和脂质代谢参数均随时间下降，然后从第一年开始基本保持稳定。术后两年，短BPL组T2DM缓解率（糖化血红蛋白≤6%）为31.2%，长BPL组为37.5%（p = 0.685）。
在总小肠旷置长度（AL + BPL）一致的情况下，将BPL从30 cm延长至100 cm不影响RYGB术后的血糖控制和体重减轻。
