Clinical efficacy and influencing factors of 3D laparoscopic sleeve gastrectomy for the treatment of obesity combined with type 2 diabetes mellitus

doi:10.3877/cma.j.issn.1674-3946.2024.02.009

Abstract

Abstract:

Objective

To study 3D laparoscopic sleeve gastrectomy (LSG) in the treatment of type 2 diabetes mellitus (T2DM) combined with obesity and observe its clinical efficacy, and analyze the factors influencing LSG in the treatment of T2DM.

Methods

Clinical data of 65 obese patients with T2DM treated with LSG from January 2019 to January 2022 were reviewed and analyzed. Follow-up was performed at months 1, 3, 6, and 12 within 1 year after surgery. Statistical analysis was performed using SPSS 26.0, and the measurement data were expressed as () deviation with independent samples t test. Count data were analyzed using the χ² test, and logistic regression analysis was used to investigate the multiple factors affecting clinical outcomes. Differences were considered statistically significant at P<0.05.

Results

All patients completed 1-year postoperative follow-up, and no patients dropped out. BMI, fasting glucose (FPG), fasting C-peptide, hemoglobin A1c (HbA1c), total cholesterol (CHOL), triglycerides (TG), and fasting insulin levels (FINS) were all in remission at 1 year postoperatively. Multivariate analysis showed that the duration of T2DM disease, C-peptide, and FINS were factors influencing the efficacy of T2DM after LSG.

Conclusion

LSG has a significant therapeutic effect on T2DM patients while reducing body weight, but its long-term efficacy needs further validation.

Key words: Sleeve Gastrectomy, Bariatric Surgery, Laparoscopy, Obesity, Type 2 Diabetes Mellitus

Shuai Zhao, Wei Wang, Ruiqi Li, Jiajie Zhou, Daorong Wang. Clinical efficacy and influencing factors of 3D laparoscopic sleeve gastrectomy for the treatment of obesity combined with type 2 diabetes mellitus[J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2024, 18(02): 146-149.

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Figures/Tables 3

References 15

［1］	Matta J，Carette C，Rives Lange C，et al. French and worldwide epidemiology of obesity［J］. Presse Med，2018，47（5）:434-438.
［2］	朱晒红，李鹏洲，高祥，等. 腹腔镜减重代谢袖状胃手术要点与适应证［J/CD］. 中华普外科手术学杂志（电子版），2020，14（02）:113-116.
［3］	刘文明，罗良弢，曹少祥，等. 腹腔镜袖状胃切除术治疗肥胖合并2型糖尿病的早期临床疗效分析［J/CD］. 中华普外科手术学杂志（电子版），2021，15（01）:69-72.
［4］	中华医学会外科学分会甲状腺及代谢外科学组，中国医师协会外科医师分会肥胖和糖尿病外科医师委员会. 中国肥胖及2型糖尿病外科治疗指南（2019版）［J］. 中国实用外科杂志，2019，39（04）:301-306.
［5］	Riddle MC，Cefalu WT，Evans PH，et al. Consensus report: definition and interpretation of remission in type 2 diabetes［J］. Diabetologia，2021，64（11）:2359-2366.
［6］	Sun H，Saeedi P，Karuranga S，et al. IDF Diabetes Atlas: Global，regional and country-level diabetes prevalence estimates for 2021 and projections for 2045［J］. Diabetes Res Clin Pract，2022，183:109119.
［7］	中国医师协会外科医师分会肥胖和糖尿病外科医师委员会，中国肥胖代谢外科研究协作组. 中国肥胖代谢外科数据库：2021年度报告［J/CD］. 中华肥胖与代谢病电子杂志，2022，08（01）:15-23.
［8］	Switzer NJ，Prasad S，Debru E，et al. Sleeve Gastrectomy and Type 2 Diabetes Mellitus: a Systematic Review of Long-Term Outcomes［J］. Obes Surg，2016，26（7）:1616-1621.
［9］	Murshid KR，Alsisi GH，Almansouri FA，et al. Laparoscopic sleeve gastrectomy for weight loss and treatment of type 2 diabetes mellitus［J］. J Taibah Univ Med Sci，2021，16（3）:387-394.
［10］	Hany M，Demerdash HM，Zidan A，et al. Effect of Weight Regain on Body Composition and Metabolic Biomarkers After Sleeve Gastrectomy: a Cross-Sectional Study from a Hospital Database［J］. Obes Surg，2023，33（1）:268-278.
［11］	Lampropoulos C，Mulita F，Alexandrides T，et al. Ghrelin，glucagon-like peptide-1，and peptide YY secretion in patients with and without weight regain during long-term follow-up after bariatric surgery: a cross-sectional study［J］. Prz Menopauzalny，2022，21（2）:97-105.
［12］	Lefere S，Onghena L，Vanlander A，et al. Bariatric surgery and the liver-Mechanisms，benefits，and risks［J］. Obes Rev，2021，22（9）:e13294.
［13］	Steenackers N，Vanuytsel T，Augustijns P，et al. Effect of sleeve gastrectomy and Roux-en-Y gastric bypass on gastrointestinal physiology［J］. Eur J Pharm Biopharm，2023，183:92-101.
［14］	Kim KS，Peck BC，Hung YH，et al. Vertical sleeve gastrectomy induces enteroendocrine cell differentiation of intestinal stem cells through bile acid signaling［J］. JCI Insight，2022，7（11）:e154302.
［15］	Kural A，Khan I，Seyit H，et al. Changes in the gut microbiota of morbidly obese patients after laparoscopic sleeve gastrectomy［J］. Future Microbiol，2022，17:5-15.

指标	术前	术后1月	术后3月	术后6月	术后12月
BMI（kg/m²）	39.1±4.1	37.0±4.2^ab	33.3±3.8^ab	30.2±3.7^ab	27.1±4.2^ab
FPG（mmol/L）	10.4±2.6	9.3±2.5^ab	8.4±2.3^ab	7.0±2.9^ab	6.2±1.4^ab
C肽（ng/ml）	3.9±1.8	3.6±2.1	3.2±1.5^b	2.6±1.6^ab	2.1±0.7^ab
HbA1c（%）	8.3±1.5	7.8±1.1^ab	7.2±1.3^ab	6.2±1.2^ab	5.7±0.9^ab
CHOL（mmol/L）	5.5±1.4	5.1±1.2	4.8±1.0^b	4.4±1.5^b	4.3±0.8^b
TG（mmol/L）	2.3±0.9	1.8±0.8^ab	1.7±0.5^b	1.5±0.4^ab	1.3±0.5^ab
FINS（μIU/L）	27.9±6.2	18.1±5.5^ab	16.2±6.0^b	12.5±5.2^ab	11.6±4.0^b

指标	术前	术后1月	术后3月	术后6月	术后12月
BMI（kg/m²）	39.1±4.1	37.0±4.2^ab	33.3±3.8^ab	30.2±3.7^ab	27.1±4.2^ab
FPG（mmol/L）	10.4±2.6	9.3±2.5^ab	8.4±2.3^ab	7.0±2.9^ab	6.2±1.4^ab
C肽（ng/ml）	3.9±1.8	3.6±2.1	3.2±1.5^b	2.6±1.6^ab	2.1±0.7^ab
HbA1c（%）	8.3±1.5	7.8±1.1^ab	7.2±1.3^ab	6.2±1.2^ab	5.7±0.9^ab
CHOL（mmol/L）	5.5±1.4	5.1±1.2	4.8±1.0^b	4.4±1.5^b	4.3±0.8^b
TG（mmol/L）	2.3±0.9	1.8±0.8^ab	1.7±0.5^b	1.5±0.4^ab	1.3±0.5^ab
FINS（μIU/L）	27.9±6.2	18.1±5.5^ab	16.2±6.0^b	12.5±5.2^ab	11.6±4.0^b

指标	例数	缓解（n=51）	未缓解（n=14）	t/χ²值	P值
性别（例）				0.867	0.352
男	30	22	8
女	35	29	6
年龄（岁，）		30.1±7.9	31.1±12.2	0.297	0.770
T2DM病程（年，）		5.7±2.5	9.0±3.3	4.155	0.000
高血压（例）				0.146	0.703
是	25	19	6
否	40	32	8
吸烟（例）				0.908	0.341
是	21	15	6
否	44	36	8
饮酒（例）				0.205	0.651
是	20	15	5
否	45	36	9
BMI（kg/m²，）		39.3±4.1	37.9±4.5	1.189	0.239
FPG（mmol/L，）		10.0±2.5	11.9±2.9	2.465	0.016
C肽（ng/ml，）		4.3±1.7	2.5±1.3	3.687	0.000
HbA1c（%，）		8.2±1.4	8.6±1.6	0.955	0.343
CHOL（mmol/L，）		5.4±1.4	5.8±1.3	0.916	0.363
TG（mmol/L，）		2.3±0.8	2.5±1.1	1.066	0.291
FINS（μIU/L，）		22.9±4.0	29.3±6.0	3.761	0.000

指标	例数	缓解（n=51）	未缓解（n=14）	t/χ²值	P值
性别（例）				0.867	0.352
男	30	22	8
女	35	29	6
年龄（岁，）		30.1±7.9	31.1±12.2	0.297	0.770
T2DM病程（年，）		5.7±2.5	9.0±3.3	4.155	0.000
高血压（例）				0.146	0.703
是	25	19	6
否	40	32	8
吸烟（例）				0.908	0.341
是	21	15	6
否	44	36	8
饮酒（例）				0.205	0.651
是	20	15	5
否	45	36	9
BMI（kg/m²，）		39.3±4.1	37.9±4.5	1.189	0.239
FPG（mmol/L，）		10.0±2.5	11.9±2.9	2.465	0.016
C肽（ng/ml，）		4.3±1.7	2.5±1.3	3.687	0.000
HbA1c（%，）		8.2±1.4	8.6±1.6	0.955	0.343
CHOL（mmol/L，）		5.4±1.4	5.8±1.3	0.916	0.363
TG（mmol/L，）		2.3±0.8	2.5±1.1	1.066	0.291
FINS（μIU/L，）		22.9±4.0	29.3±6.0	3.761	0.000

指标	B值	B值标准误	Wald值	P值	OR值	HR(95%CI)
T2DM病程	0.479	0.222	3.686	0.031	1.614	1.044-2.495
FPG	0.217	0.227	0.920	0.337	1.243	0.797-1.938
C肽	-1.095	0.426	6.596	0.010	0.335	0.145-0.772
FINS	-0.380	0.135	7.848	0.005	0.684	0.525-0.892

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