【作者】 赵文嫣；

【导师】 刘金钢；

【作者基本信息】 中国医科大学 ， 外科学， 2010， 硕士

【摘要】 目的目前肥胖患者数量迅速增长,减肥手术已经成为治疗肥胖症的最有效手段之一,近年来研究发现,减肥手术治疗肥胖症的同时,对其合并的2型糖尿病(T2DM)有治疗作用。本研究旨在评价现行的三种腹腔镜减肥手术对肥胖症合并T2DM的近期治疗效果,从而为T2DM的手术治疗提供临床依据。方法选择2007年至2009年于中国医科大学附属盛京医院进行腹腔镜减肥手术的肥胖症合并2型糖尿病患者15例,其中6例施行腹腔镜可调节胃捆扎带手术(LAGB),5例施行腹腔镜袖状胃切除术(LSG),4例施行腹腔镜胃旁路手术(LGB),术后进行至少6个月的随访,采集每名患者术后1,3,6个月BMI(体重指数)、FPG(空腹血糖)及HbAlc[糖化血红蛋白)值,计算相应的EBMIL%(多余体重指数减少百分比)、△FPG%(空腹血糖减少百分比)及△HbAlc%(糖化血红蛋白减少百分比)。结果应用统计学方法分析。结果各组患者术后1,3,6个月BMI、FPG及HbAlc水平均呈现出程度不同的改善。比较术后各随访时间点各组患者EBMIL%(多余体重指数减少百分比)、△FPG%(空腹血糖减少百分比)及△HbAlc%(糖化血红蛋白减少百分比),LAGB组与LSG组相比较在三者差异不大(P>0.05)；LGB组与LSG组、LGB组与LAGB组则在三者均有统计学差异(P<0.05)。即认为：施行腹腔镜胃旁路手术组患者的近期减重和对2型糖尿病治疗效果均较施行腹腔镜可调节胃捆扎带手术或袖状胃切除术患者的疗效明显。而施行腹腔镜可调节胃捆扎带手术与袖状胃切除术患者的减重及2型糖尿病治疗效果无明显差异。结论因为LGB的近期减重效果及对2型糖尿病治疗效果更加明显,但因手术创伤及难度较大,术后并发症较多,且可能出现吸收不良、贫血、骨质疏松等较多长期并发症,故适用于年龄偏大,肥胖症或合并的2型糖尿病病情严重的患者,以达到快速减重及缓解2型糖尿病病情的目的。LSG及LGB术后近期的减重及对糖尿病疗效肯定,差异不大,但LSG应用前景更为广阔,因此年轻、肥胖症或合并的2型糖尿病病情较轻的患者,更适用于LSG,以避免LGB长期并发症出现。更多还原

【Abstract】 ObjectiveThe number of obesity quickly increases currently, bariatric surgery has become one of the most effect methods for therapy of obese patient. Study in recent years found that the bariatric surgeries also has therapeutic effect on obesity T2DM. So the research is designed to investigate the relieving of type 2 diabetes in short-term after obese patients received bariatric surgery,providing clinical basis for the surgical operation treatment of T2DM.MethodsThe clinical data of 15 patients who was diagnosis as obesity combine with T2DM were undergone laparoscopic bariatric surgery in Shengjing hospital of China Medical University from 2007 to 2009. According to the methods of operation The patients were divided into 3 groups:Laparoscopic adjustable gastric banding(LAGB) group(6 cases), Laparoscopic sleeve gastrectomy(LSG)group(5 cases), Laparoscopic gastric bypass(LGB) group (4 cases).Then we make a 6-month follow-up at least, collect the BMI、FPG and HbAlc at different time point,at last we compared the EBMIL%、△FPG% and△HbAlc% between the 3 groups by using a statistical method.ResultsAll the group show different post-operation curative improvement on level of BMI、FPG and HbAlc.We make comparison on EBMIL%,△FPG% and△HbAlc% between the 3 groups.The LGB group represented a more satisfactory curative effect for both obesity and T2DM (P＜0.05).However,there was no significant difference between the LAGB group and the LSG group in the preceding 2 facets (P>0.05).So we regard that in shout-term after oprations,LGB is a more effective means for treatment of obesity T2DM,while the other two methods has no significant differences on the 2 aspects.ConclusionsLGB appears a more effective short-term therapeutical results on obesity T2DM.However,it makes relatively serious hurts and has much difficulties on skills,meanwhile,it is easy to cause more complications both in periopration period and postopration period.So it is more suitable for patients whose age is relatively old,obesity or with a serious state of T2DM to receive a LGB operation,which could lose reduce body weight and ameliorate the illness status more quickly.While the therapy effects of LSG and LGB operations should be also confirmed,and the two methods are likely to fit for the younger patients with obesity or whose T2DM is tempered,moreover, the application prospect of LSG is more extensive.更多还原