Xing Ying, Bai Ri-Xing, Li You-Guo, Xu Jun, Zhong Zhi-Qiang, Yan Ming, Yan Wen-Mao
Department of General Surgery, Beijing Tiantan Hospital, Beijing 100170, China.
World J Clin Cases. 2024 Sep 6;12(25):5697-5705. doi: 10.12998/wjcc.v12.i25.5697.
Bariatric and metabolic surgery have been routinely performed following the rapid increase in obesity and metabolic diseases worldwide. Of all evolving procedures, Roux-en-Y gastric bypass (RYGB) is considered the gold standard for surgical treatment of patients with type 2 diabetes mellitus (T2DM) and obesity. RYGB was introduced in China nearly 20 years ago, but the number of RYGB surgeries only accounts for 3.1% of the total number of weight loss and metabolic surgeries in China, it's effect on Chinese people still needs further study.
To investigate the effect and safety of a modified gastric bypass performed in Chinese patients with T2DM.
Patients with obesity and T2DM who underwent modified gastric bypass, with > 5-year follow-up data, were analyzed.
All 37 patients underwent uneventful laparoscopic surgery, no patient was switched to laparotomy during the surgery, and no severe complications were reported. Average weight and body mass index of the patients reduced from 84.6 ± 17.3 (60.0-140.0) kg and 30.9 ± 5.0 (24.7-46.2) kg/m to 67.1 ± 12.2 (24.7-46.2) kg and 24.6 ± 3.9 (17.7-36.5) kg/m, respectively, and fasting plasma glucose and glycated hemoglobin decreased from 7.4 ± 3.4 mmol/L and 8.2% ± 1.7% preoperatively to 6.5 ± 1.3 mmol/L and 6.5% ± 0.9% 5-years postoperatively, respectively. Only 29.7% (11/37) of the patients used hypoglycemic drugs 5-years postoperatively, and the complete remission rate of T2DM was 29.7% (11/37). Triglyceride level reduced significantly but high-density lipoprotein increased significantly (both < 0.05) compared with those during the preoperative period. Liver and renal function improved significantly postoperatively, and binary logistic regression analysis revealed that the patients' preoperative history of T2DM and fasting C-peptide were significant prognostic factors influencing complete T2DM remission after RYGB ( = 0.006 and 0.012, respectively).
The modified gastric bypass is a safe and feasible procedure for Chinese patients with obesity and T2DM, exhibiting satisfactory amelioration of weight problems, hyperglycemia, and combination disease.
随着全球肥胖症和代谢性疾病的迅速增加，减重与代谢手术已常规开展。在所有不断发展的手术中， Roux-en-Y胃旁路术（RYGB）被认为是2型糖尿病（T2DM）和肥胖症患者手术治疗的金标准。RYGB于近20年前引入中国，但RYGB手术数量仅占中国减重与代谢手术总数的3.1%，其对中国人的疗效仍需进一步研究。
探讨改良胃旁路术治疗中国T2DM患者的疗效及安全性。
分析接受改良胃旁路术且有超过5年随访数据的肥胖和T2DM患者。
37例患者均顺利接受腹腔镜手术，术中无患者转为开腹手术，未报告严重并发症。患者的平均体重和体重指数分别从84.6±17.3（60.0 - 140.0）kg和30.9±5.0（24.7 - 46.2）kg/m²降至67.1±12.2（24.7 - 46.2）kg和24.6±3.9（17.7 - 36.5）kg/m²，空腹血糖和糖化血红蛋白分别从术前的7.4±3.4 mmol/L和8.2%±1.7%降至术后5年的6.5±1.3 mmol/L和6.5%±0.9%。术后5年仅有29.7%（11/37）的患者使用降糖药物，T2DM的完全缓解率为29.7%（11/37）。与术前相比，甘油三酯水平显著降低，高密度脂蛋白显著升高（均P<0.05）。术后肝肾功能显著改善，二元logistic回归分析显示，患者术前T2DM病史和空腹C肽是影响RYGB术后T2DM完全缓解的重要预后因素（分别为P = 0.006和0.012）。
改良胃旁路术对中国肥胖和T2DM患者是一种安全可行的手术，在改善体重问题、高血糖及合并症方面表现出令人满意的效果。
