两种代谢手术治疗肥胖型2型糖尿病的对比分析

doi:10.3877/cma.j.issn.1674-3946.2020.05.014

中华普外科手术学杂志(电子版) ›› 2020, Vol. 14 ›› Issue (05) : 476 -479. doi: 10.3877/cma.j.issn.1674-3946.2020.05.014

所属专题：文献；

论著

两种代谢手术治疗肥胖型2型糖尿病的对比分析

朱信强¹, 单晓东², 马济雷¹, 黄海龙¹, 蒋学通¹, 吴建强¹, 孙喜太²^,^†(

)

^1. 223800　江苏宿迁，徐州医科大学附属宿迁医院普外科
^2. 210008　南京，南京大学医学院附属鼓楼医院　普外科

收稿日期:2020-03-06 出版日期:2020-10-26
通信作者: 孙喜太

Comparative analysis of two types of metabolic surgery for obese patients with type 2 diabetes

Xinqiang Zhu¹, Xiaodong Shan², Jilei Ma¹, Hailong Huang¹, Xuetong Jiang¹, Jianqiang Wu¹, Xitai Sun²^,^†()

^1. Department of General Surgery, Suqian Hospital, Xuzhou Medical University, Jiangsu 223800, China
^2. Department of General Surgery, Nanjing Drum Tower Hospital, Nanjing University Medical School, Jiangsu 210008, China

Received:2020-03-06 Published:2020-10-26
Corresponding author: Xitai Sun
About author:
Corresponding author: Sun Xitai, Email: sunxitai@vip.qq.com
Supported by:
The 5th " 333 project" of training fund of Jiangsu Province(BRA2019230)

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引用本文：

朱信强, 单晓东, 马济雷, 黄海龙, 蒋学通, 吴建强, 孙喜太. 两种代谢手术治疗肥胖型2型糖尿病的对比分析[J/OL]. 中华普外科手术学杂志(电子版), 2020, 14(05): 476-479.

Xinqiang Zhu, Xiaodong Shan, Jilei Ma, Hailong Huang, Xuetong Jiang, Jianqiang Wu, Xitai Sun. Comparative analysis of two types of metabolic surgery for obese patients with type 2 diabetes[J/OL]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2020, 14(05): 476-479.

目的

评价两种手术方式对治疗肥胖伴有2型糖尿病(T2DM)的优势。

方法

回顾分析2012年1月至2019年2月两家医院收治的64例肥胖伴有T2DM的临床资料，根据手术干预情况分为两组，腹腔镜下SG(LSG组) 30例和腹腔镜下胃旁路手术(L-RYGB组) 34例，采用SPSS 17软件进行统计分析。生化指标等计量资料以(±s)表示，采用独立t检验。术后并发症等计数资料采用χ²检验，采用logistic回归(逐步)模型，分析T2DM缓解与否的危险因素，P<0.05为差异有统计学意义。

结果

两组患者术后1年血脂相关指标除甘油三酯外，两种手术方法均未获得明显改善。两组间BMI和血糖比较差异无统计学意义(P>0.05)；L-RYGB对血糖的缓解率(88.2%)优于LSG(76.7%)P<0.05。而术后1年，两组接受治疗的患者的HbA1c、收缩压和舒张压减少值均明显降低(P＝0.016; P＝0.029和P＝0.017)，多因素logistic回归分析，BMI、空腹血糖、HbA1c可作为1年时T2DM缓解的独立危险因素(P＝0.001; P＝0.001; P＝0.008)。L-RYGB显示出T2DM缓解率明显高于LSG (OR＝1.79, 95%CI: 1.133～2.829, P＝0.013)。两组患者均未发生30d内死亡和胃肠瘘。在深静脉血栓形成的并发症中，L-RYGB的发生率较高(11.8% vs.3.3%, P＝0.022)。

结论

在T2DM缓解方面，术后1年的结论，L-RYGB优于LSG。远期持久缓解的结果，仍需更长时间的随访研究。

关键词: 糖尿病，2型, 肥胖症, 胃旁路术, 胃切除术, 疗效比较研究, 代谢手术

Objective

To evaluate the advantages of types of metabolic surgery for obese patients with type 2 diabetes (T2DM).

Methods

From January 2012 to February 2019, the clinical data of 64 cases of obesity with T2DM were retrospectively analyzed. According to the surgical intervention, 64 patients were divided into laparoscopic sleeve gastrectomy (LSG) group (n=30) and laparoscopic gastric bypass surgery (L-RYGB) group (n=34) . Statistical analysis were performed by using SPSS 17 software. Measurement data such as biochemical indicators were represented as (±s), and were examined by using independent t test. Postoperative complications and other count data were analyzed using χ² test and logistic regression (stepwise) model to analyze the risk factors of diabetes remission. A P value of <0.05 was considered as statistically significant difference.

Results

Except for triglycerides, the blood lipid-related indexes in both two groups were not improved significantly one year after surgery. There were no significant difference in terms of BMI and blood glucose between two groups (P>0.05). In terms of remission rate of blood glucose, there was 88.2% in L-RYGB, which was better than76.7% in LSG group, with significant difference (P<0.05). One year after surgery, there were significant decrease in both groups in terms of HbA1c、systolic blood pressure and diastolic blood pressure (P=0.016; P=0.029 and P=0.017 respectively). Multivariate logistic regression analysis showed that BMI, fasting blood glucose and HbA1c could be used as independent risk factors for diabetes remission at 1 year (P=0.001; P=0.001; P=0.008). There was a higher remission rate in L-RYGB group than that in LSG group, with significant difference (OR=1.79, 95%CI: 1.133~2.829, P=0.013). There was no death or gastrointestinal fistula within 30 days in either group. There was a higher incidence of deep vein thrombosis in L-RYGB group than that in LSG group (11.8% vs.3.3%, P=0.022).

Conclusion

In terms of diabetes remission one year after surgery, gastric bypass surgery is superior to sleeve gastrectomy. However, follow-up studies are still needed for long-term remission outcome.

Key words: Diabetes mellitus, type 2, Obesity, Gastric bypass, Gastrectomy, Comparative effectiveness research, Metabolic surgery

表1 64例肥胖型T2DM患者不同减重手术方式两组患者基线资料[(±s)，例]

组别	例	年龄	男性	治疗方案	高血压	糖尿病>10年	未用药
组别	例	年龄	男性	A/B	高血压	糖尿病>10年	未用药
LSG	30	45.4±11.0	17	9/16	17	9	5
L-RYGB	34	47.6±10.7	15	9/17	26	9	8
P value	?	0.086	0.386	0.714	0.065	1.447	0.325

表1 64例肥胖型T2DM患者不同减重手术方式两组患者基线资料[(±s)，例]

组别	例	年龄	男性	治疗方案	高血压	糖尿病>10年	未用药
组别	例	年龄	男性	A/B	高血压	糖尿病>10年	未用药
LSG	30	45.4±11.0	17	9/16	17	9	5
L-RYGB	34	47.6±10.7	15	9/17	26	9	8
P value	?	0.086	0.386	0.714	0.065	1.447	0.325

表2 64例肥胖型T2DM患者不同减重手术方式两组患者术后1年可控性参数对比(±s)

组别	例	?	BMI(kg/m²)	血糖(mg/dl)	HbA1c(%)	缓解(%)
LSG	30	术前	35.2±5.1^b	183.2±47.0^b	8.2±1.5^b	-
?	?	术后	26.5±2.7	106.4±18.5	6.1±0.8	23(76.7)
L-RYGB	34	术前	36.7±7.3^b	165.8±48.8^b	8.8±1.6^b	-
?	?	术后	27.4±5.6	99.4±18.5	5.7±0.7^△	30(88.2)^△
组别	例	?	总胆固醇	HDL	LDL
LSG	30	术前	176.9±29.5^a	42.5±10.6^a	121.3±40.9^a
?	?	术后	176.7±25.3	50.7±11.4	106.2±27.6
L-RYGB	34	术前	180.4±41.3^a	43.3±12.6^a	122.8±36.9^a
?	?	术后	166.5±26.9	52.1±15.3	105.2±30.3
组别	例	?	三油甘脂	血压
组别	例	?	三油甘脂	收缩压均值	舒张压均值
LSG	30	术前	201.2±111.8^b	139.3±14.7^b	90.4±12.9^b
?	?	术后	138.6±48.4	127.4±12.6	82.5±12.4
L-RYGB	34	术前	203.8±109.5^b	140.8±18.5^b	97.1±11.5^b
?	?	术后	139.6±52.7	126.6±14.2^△	78.8±10.8^△

表2 64例肥胖型T2DM患者不同减重手术方式两组患者术后1年可控性参数对比(±s)

组别	例	?	BMI(kg/m²)	血糖(mg/dl)	HbA1c(%)	缓解(%)
LSG	30	术前	35.2±5.1^b	183.2±47.0^b	8.2±1.5^b	-
?	?	术后	26.5±2.7	106.4±18.5	6.1±0.8	23(76.7)
L-RYGB	34	术前	36.7±7.3^b	165.8±48.8^b	8.8±1.6^b	-
?	?	术后	27.4±5.6	99.4±18.5	5.7±0.7^△	30(88.2)^△
组别	例	?	总胆固醇	HDL	LDL
LSG	30	术前	176.9±29.5^a	42.5±10.6^a	121.3±40.9^a
?	?	术后	176.7±25.3	50.7±11.4	106.2±27.6
L-RYGB	34	术前	180.4±41.3^a	43.3±12.6^a	122.8±36.9^a
?	?	术后	166.5±26.9	52.1±15.3	105.2±30.3
组别	例	?	三油甘脂	血压
组别	例	?	三油甘脂	收缩压均值	舒张压均值
LSG	30	术前	201.2±111.8^b	139.3±14.7^b	90.4±12.9^b
?	?	术后	138.6±48.4	127.4±12.6	82.5±12.4
L-RYGB	34	术前	203.8±109.5^b	140.8±18.5^b	97.1±11.5^b
?	?	术后	139.6±52.7	126.6±14.2^△	78.8±10.8^△

表3 64例肥胖型T2DM患者减重手术后影响缓解的独立危险因素

影响因素	B	SE	Wals卡方值	OR	95%置信区间	P值
BMI	0.126	0.238	8.234	1.061	1.026～1.098	0.001
空腹血糖	0.005	0.263	2.147	1.199	1.098～1.309	0.0010
HbA1c	0.116	0.445	0.289	1.205	1.039～1.396	0.008
术式	1.119	1.456	3.345	1.79	1.133～2.829	0.013

表3 64例肥胖型T2DM患者减重手术后影响缓解的独立危险因素

影响因素	B	SE	Wals卡方值	OR	95%置信区间	P值
BMI	0.126	0.238	8.234	1.061	1.026～1.098	0.001
空腹血糖	0.005	0.263	2.147	1.199	1.098～1.309	0.0010
HbA1c	0.116	0.445	0.289	1.205	1.039～1.396	0.008
术式	1.119	1.456	3.345	1.79	1.133～2.829	0.013

表4 64例肥胖型T2DM患者不同减重手术方式两组患者术后早期相关并发症比较[例(%)]

组别	例	切口感染	腹腔出血	深静脉血栓	肺栓塞
LSG	30	3(10.0)	1 (3.3)	1(3.3)	1(3.3)
L-RYGB	34	5(14.7)	2(5.9)	4(11.8)	1 (2.9)
P	?	0.332	0.179	0.022	0.415

表4 64例肥胖型T2DM患者不同减重手术方式两组患者术后早期相关并发症比较[例(%)]

组别	例	切口感染	腹腔出血	深静脉血栓	肺栓塞
LSG	30	3(10.0)	1 (3.3)	1(3.3)	1(3.3)
L-RYGB	34	5(14.7)	2(5.9)	4(11.8)	1 (2.9)
P	?	0.332	0.179	0.022	0.415

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Comparative analysis of two types of metabolic surgery for obese patients with type 2 diabetes

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Comparative analysis of two types of metabolic surgery for obese patients with type 2 diabetes