摘要
目的:探讨胃旁路术(Roux-en-Y gastric bypass, RYGB)对2型糖尿病(Type 2 diabetes mellitus, T2DM)患者的长期疗效及安全性。方法:检索首都医科大学附属北京天坛医院接受RYGB治疗的T2DM患者，选取术后随访满5年、数据完善的病例，分析术前、术后患者的体重、血糖、合并疾病、营养等指标的变化以及手术远期并发症发生情况。结果:37例行RYGB的T2DM患者入组。平均随访6.2(5.0~9.0)年。术后5年，体重、糖化血红蛋白(HbA1c)均较术前明显减低，差异均有统计学意义(P均<0.05)。术后5年仅有29.7%的患者使用降糖药物，较术前的糖尿病用药情况明显减低，差异有统计学意义(P<0.01)。术后5年T2DM的完全缓解率为29.7%。与术前相比，术后5年甘油三酯(triglyceride，TG)明显减低，高密度脂蛋白(high density lipoprotein，HDL)明显升高，脂代谢异常以及肝功能异常人数明显减少，差异均有统计学意义(P均<0.05)。在营养方面，术后5年铁蛋白水平较术前明显减低，差异有统计学意义(P<0.05)。血红蛋白、白蛋白、叶酸、维生素B12均较术前减低，但差异无统计学意义(P均>0.05)。术后5年1例(3.0%)伴有反复不全肠梗阻症状，2例(6.0%)新发胆囊结石，6例(18.2%)出现缺铁性贫血。结论:RYGB对于T2DM患者远期仍是安全、有效的。RYGB术后存在体重、血糖反弹、营养障碍等风险。术后应重视患者的随访、饮食及用药指导，RYGB术后患者要预防性补充铁剂、维生素及各种微量元素。
Abstract
Objective:To investigate the long-term efficacy and safety of gastric bypass(Roux-en-Y gastric bypass, RYGB)on patients with type 2 diabetes mellitus(T2DM).Methods:T2DM patients who received RYGB in Beijing Tiantan Hospital Affiliated to Capital Medical University were retrieved from Bariatric and Metabolic Surgery Database. Cases with complete data after 5 years of postoperative follow-up were selected to analyze the preoperative and postoperative weight, blood glucose, and combined changes in indicators such as disease and nutrition, as well as the occurrence of long-term complications of surgery.Results:Thirty-seven patients with T2DM undergoing RYGB were enrolled. The mean follow-up was 6.2(5.0-9.0)years. Five years after operation, body weight and glycosylated hemoglobin(HbA1c) of all were significantly lower than those before operation, and the differences were statistically significant (all P values were less than 0.05). Only 29.7% of the patients used hypoglycemic drugs 5 years after operation, which was significantly lower than that before operation, and the difference was statistically significant(P<0.01). The complete remission rate of T2DM after 5 years was 29.7%. Compared with before operation, triglyceride(TG)was significantly reduced, high-density lipoprotein(HDL)was significantly increased, and the number of abnormal lipid metabolism and abnormal liver function were significantly reduced at 5 years after operation, and the differences were statistically significant(P value are less than 0.05). In terms of nutrition, the level of ferritin at 5 years after operation was significantly lower than that before operation, and the difference was statistically significant(P<0.05). Hemoglobin, albumin, folic acid, and vitamin B12 were all lower than those before operation, but the differences was not statistically significant(all P values were greater than 0.05). Five years after operation, 1 case(3.0%)was accompanied by symptoms of recurrent incomplete intestinal obstruction, 2 cases(6.0%)developed new gallbladder stones, and 6 cases(18.2%)developed iron deficiency anemia.Conclusion:In the long run, RYGB is safe and effective for T2DM patients. After RYGB, there are risks such as weight, blood sugar rebound, and nutritional disorders. Postoperative follow-up, diet and medication guidance should be paid attention to. Patients after RYGB should be supplemented with iron, vitamins and various trace elements preventively.
基金项目
首都卫生发展科研专项重点项目(2020-1-2021)
万方数据