Vennapusa Amar, Panchangam Ramakanth Bhargav, Kesara Charita, Madivada Mukharjee Ss
Department of Bariatric & Metabolic Surgery, Dr. Amar Bariatric & Metabolic Center, Hyderabad, Telangana, India.
Department of Endocrine and Metabolic Surgery, Endocare Hospital, Vijayawada, Andhra Pradesh, India.
J Metab Bariatr Surg. 2020 Dec;9(2):33-41. doi: 10.17476/jmbs.2020.9.2.33. Epub 2020 Dec 31.
Laparoscopic sleeve gastrectomy with loop duodenojejunal bypass (SLDJB) is a novel metabolic surgery that is a modification of the single anastomosis duodenoileal bypass with sleeve. Compared to conventional surgeries, SLDJB is highly effective in inducing diabetes remission. This study analyzed the metabolic efficacy of SLDJB.
Seventy-eight patients with obesity and diabetes who underwent SLDJB between May 2013 and October 2017 were retrospectively analyzed to investigate the efficacy of their surgery and diabetes remission predictors. Complete diabetes remission was defined as an HbA1 level <6% with cessation of insulin and oral hypoglycemic agents.
Complete diabetes remission occurred in 80.52% and 76.71% of patients at 1- and 3-year follow-ups, respectively. There was no significant difference in the rates of complete diabetes remission between the groups based on gender, preoperative body mass index (BMI), diabetes duration or preoperative insulin use. There was a significantly higher rate of complete remission in patients <50 years of age at the 1-year follow-up. Additionally, the rate of complete remission was significantly less when preoperative glycemic control was poor. Preoperative HbA1 levels negatively predicted complete remission, but was significant only at the 3-year follow-up.
SLDJB is highly effective in treating obesity with type 2 diabetes, and preoperative glycemic control was found to predict complete remission. Patients under 50 years of age had a better short-term response rate; however, the surgery was effective regardless of gender, preoperative BMI, duration of diabetes or preoperative insulin use.
带袢十二指肠空肠旁路的腹腔镜袖状胃切除术（SLDJB）是一种新型代谢手术，是对单吻合十二指肠回肠旁路袖状胃切除术的改良。与传统手术相比，SLDJB在诱导糖尿病缓解方面非常有效。本研究分析了SLDJB的代谢疗效。
回顾性分析2013年5月至2017年10月期间接受SLDJB的78例肥胖和糖尿病患者，以研究手术疗效及糖尿病缓解的预测因素。完全糖尿病缓解定义为糖化血红蛋白（HbA1）水平<6%且停用胰岛素和口服降糖药。
在1年和3年随访时，分别有80.52%和76.71%的患者实现完全糖尿病缓解。基于性别、术前体重指数（BMI）、糖尿病病程或术前胰岛素使用情况分组，各组间完全糖尿病缓解率无显著差异。1年随访时，年龄<50岁的患者完全缓解率显著更高。此外，术前血糖控制不佳时，完全缓解率显著更低。术前HbA1水平对完全缓解有负向预测作用，但仅在3年随访时具有统计学意义。
SLDJB在治疗2型糖尿病肥胖症方面非常有效，且发现术前血糖控制可预测完全缓解。50岁以下患者短期缓解率更佳；然而，无论性别、术前BMI、糖尿病病程或术前胰岛素使用情况如何，该手术均有效。
