本文選題：體重指數(shù) + 腹腔鏡胃旁路術(shù)�。� 參考：《南方醫(yī)科大學(xué)》2015年碩士論文

【摘要】：背景糖尿病是一組常見(jiàn)的以葡萄糖和脂肪代謝紊亂、血漿葡萄糖水平增高為特征的代謝內(nèi)分泌疾�。浩渲�,T2DM(2型糖尿病)主要由于胰島素抵抗合并有相對(duì)性胰島素分泌不足所致。表現(xiàn)為碳水化合物、脂肪、蛋白質(zhì)、維生素、水及電解質(zhì)等代謝紊亂。糖尿病在世界范圍內(nèi)的發(fā)病率正逐年增加,據(jù)報(bào)道：2010年全球年齡在20歲～79歲的成年人糖尿病發(fā)病率為6.4%,影響2.85億成年人。WHO調(diào)查顯示：到2030年糖尿病人數(shù)將增加一倍,且新發(fā)病例主要集中在中國(guó)等發(fā)展中國(guó)家。2008年中華醫(yī)學(xué)會(huì)糖尿病學(xué)分會(huì)的一項(xiàng)研究顯示,在我國(guó)20歲以上的成年人患病率為9.7%,患病總?cè)藬?shù)超過(guò)9000萬(wàn),其中T2DM占90%。糖尿病的治療,長(zhǎng)期以來(lái)一直沿用包括：健康教育、醫(yī)學(xué)營(yíng)養(yǎng)治療、體育鍛煉、病情監(jiān)測(cè)、口服藥物治療、胰島素治療、GLP-1類似物及DPP Ⅳ抑制劑等傳統(tǒng)的治療方法。盡管上述治療方法的階梯性治療或強(qiáng)化性治療,仍有許多患者難以達(dá)到其預(yù)期的治療目標(biāo)。血糖的控制與糖尿病并發(fā)癥的減少密切相關(guān),糖尿病的并發(fā)癥對(duì)身體健康危害極大。糖尿病的危害不在于高血糖本身,而在于糖尿病可繼發(fā)各種急、慢性并發(fā)癥,嚴(yán)重威脅著人類的身體健康。糖尿病的急性并發(fā)癥包括：糖尿病酮癥酸中毒、高血糖高滲狀態(tài)。糖尿病酮癥酸中毒、高血糖高滲狀態(tài)兩者皆因胰島素相對(duì)缺乏,合并嚴(yán)重的以高血糖為特征的兩種不同的代謝紊亂。高血糖高滲狀態(tài)因胰島素不足,血糖升高,引起身體脫水,導(dǎo)致嚴(yán)重的脫水狀態(tài)。糖尿病酮癥酸中毒除胰島素嚴(yán)重缺乏、嚴(yán)重高血糖及脫水外,同時(shí),合并有酮體和酸的生成。糖尿病酮癥酸中毒、高血糖高滲狀態(tài)如得不到合理的救治可致患者的死亡。在發(fā)現(xiàn)胰島素以前,糖尿病酮癥酸中毒的死亡率幾乎為100%。研究表明糖尿病酮癥酸中毒是青少年糖尿病患者的主要死亡原因。糖尿病的慢性并發(fā)癥是對(duì)人體危害最為嚴(yán)重,是糖尿病致殘、致死的主要原因。糖尿病大血管病變可引起冠心病、心肌病變、充血性心力衰竭,心肌梗死、猝死、缺血性或出血性腦血管病、腦萎縮、腦動(dòng)脈硬化、腎動(dòng)脈硬化、肢體動(dòng)脈硬化等。糖尿病微血管病變是糖尿病的特異性并發(fā)癥,典型改變是微循環(huán)障礙和微血管基底膜增厚,可致糖尿病視網(wǎng)膜病變和糖尿病腎病等�；继悄虿�20年后,幾乎100%的1型糖尿病患者和60%的2型糖尿病患者會(huì)出現(xiàn)不同程度的視網(wǎng)膜病變。糖尿病視網(wǎng)膜病變?cè)诿绹?guó)是成人失明的主要病因。糖尿病腎病會(huì)縮短患者的壽命,影響患者的生活方式和工作,在絕大多數(shù)國(guó)家糖尿病腎病是進(jìn)展為晚期腎病的主要原因,糖尿病腎病發(fā)展到晚期,需透析或腎移植,加重患者和國(guó)家經(jīng)濟(jì)負(fù)擔(dān),是糖尿病致死的重要原因。糖尿病神經(jīng)病變可累及全身神經(jīng)的任意部分,可引起感覺(jué)異常、疼痛、感覺(jué)遲鈍、感覺(jué)消失、神經(jīng)反射消失、肌肉麻痹、肌肉萎縮、瞳孔改變、胃排空延遲、腹瀉、便秘、光反射消失、排汗異常、直立性低血壓、持續(xù)心動(dòng)過(guò)速、心搏間距延長(zhǎng),以及殘尿量增加、尿失禁、尿潴留、性功能障礙等。糖尿病足為常見(jiàn)的糖尿病慢性并發(fā)癥,是與下肢神經(jīng)病變和周?chē)懿∽兿嚓P(guān)的下肢潰瘍、感染和(或)深層組織損傷。輕者表現(xiàn)為足部畸形、皮膚干燥和發(fā)涼等；重者可表現(xiàn)為足部潰瘍、壞疽。文獻(xiàn)報(bào)道約15%的糖尿病患者將在其一生中某一階段發(fā)生足部潰瘍或壞疽,2型糖尿病患者的截肢率是非糖尿病患者的17以上倍,糖尿病足是截肢、致殘主要原因。糖尿病患者容易并發(fā)感染,感染率高,且較常人感染更嚴(yán)重,治療更困難。如患者可常發(fā)生癤、癰,遷延不愈或反復(fù)發(fā)生。皮膚真菌感染如足癬等也�？砂l(fā)生,女性患者可出現(xiàn)真菌性陰道炎和巴氏腺炎。糖尿病患者還可出現(xiàn)如毛霉菌病、惡性外耳炎、氣腫性膽囊炎、氣腫性腎盂腎炎等不常見(jiàn)感染。糖尿病患者的肺結(jié)核的發(fā)生率也較非糖尿病者高2.0-3.6倍,且疾病發(fā)展更快。此外,糖尿病還可引起各種骨關(guān)節(jié)病變、皮膚病變、影響創(chuàng)傷的愈合等。糖尿病極大地威脅著人類的身體健康和社會(huì)發(fā)展,糖尿病已成為嚴(yán)重的全球公共衛(wèi)生問(wèn)題之一,對(duì)社會(huì)和經(jīng)濟(jì)帶來(lái)了沉重的負(fù)擔(dān)。1995年,Pories醫(yī)生首先報(bào)道,合并T2DM的肥胖癥患者,在實(shí)施了減重的“胃旁路術(shù)”后,不僅獲得了顯著地“減重”效果,同時(shí)也取得了對(duì)糖尿病“血糖控制”的神奇療效。從此,人們對(duì)T2DM的治療看到了新的希望。以“胃旁路術(shù)”為代表的減重手術(shù)在T2DM的治療方面的應(yīng)用也蓬勃發(fā)展起來(lái),方興未艾。減重手術(shù)因其對(duì)T2DM卓越的治療效果,而被專家及各種指南推薦作為T(mén)2DM標(biāo)準(zhǔn)的治療措施之一。然而,目前各種指南及共識(shí)主要將BMI做為選擇病人的主要指標(biāo),對(duì)于BMI≥35kg/m2的T2DM患者可考慮代謝外科手術(shù)治療,已基本達(dá)成共識(shí)；但是,對(duì)于BMI35kg/m2的這部分患者是否能采取相同的治療,仍然存在爭(zhēng)議。1991年,NIH制定指南,在臨床證據(jù)不是很充足的情況下,首次推薦以病人的BMI作為選擇減重手術(shù)的病人的主要指標(biāo),建議：對(duì)BMI40 kg/m2的肥胖患者可以選擇減重手術(shù)；對(duì)BMI在35 kg/m2～40 kg/m2的肥胖患者,如果合并高風(fēng)險(xiǎn)的心肺問(wèn)題、嚴(yán)重的糖尿病,或合并影響生活的身體問(wèn)題,如肥胖相關(guān)的關(guān)節(jié)問(wèn)題或影響患者職業(yè)、家庭功能、運(yùn)動(dòng)等,此類患者可考慮減重手術(shù)治療。此后,各指南和衛(wèi)生機(jī)構(gòu)聲明的制定均參照NIH指南的標(biāo)準(zhǔn),將BMI作為選擇病人的主要標(biāo)準(zhǔn)。2009年,ADA(美國(guó)糖尿病協(xié)會(huì))首次推薦減重手術(shù)可用于T2DM的治療,它指出對(duì)BMI≥35kg/m2的T2DM患者可考慮減重手術(shù)治療,尤其是那些通過(guò)改變生活方式和藥物治療不滿意的患者。2011年,IDF(國(guó)際糖尿病聯(lián)盟)發(fā)表聲明,對(duì)BMI≥35kg/m2的T2DM患者,減重手術(shù)可以作為一種治療措施；對(duì)BMI在30kg/m2～35kg/m2的T2DM患者,在最佳的藥物治療效果不佳時(shí),尤其在合并其他心血管危險(xiǎn)因素的同時(shí),手術(shù)可以作為一種選擇的治療方式。在我國(guó),《手術(shù)治療糖尿病專家共識(shí)》和《中國(guó)2型糖尿病防治指南(2010年版)》指出：(1)BMI≥35 kg/m2的有或無(wú)合并癥的T2DM人群,可考慮行減重代謝手術(shù)；(2)BMI 30 kg/m2～35 kg/m2合并T2DM的人群,在生活方式和藥物治療難以控制血糖或合并癥時(shí),尤其具有心血管風(fēng)險(xiǎn)因素時(shí),手術(shù)應(yīng)是治療選擇之一；(3)BMI 28.0kg/m2～29.9kg/m2的人群中,如果其合并T2DM,并有向心性肥胖(女性腰圍85cm,男性90cm)且至少額外的符合兩條代謝綜合征標(biāo)準(zhǔn)(高甘油三酯,低高密度脂蛋白膽固醇,高血壓),減重手術(shù)應(yīng)也可考慮為治療選擇之一；(4)BMI25.0kg/m2～27.9kg/m2的T2DM病人,手術(shù)應(yīng)該被視為試驗(yàn)研究,而不應(yīng)廣泛推廣�！吨袊�(guó)糖尿病外科治療專家指導(dǎo)意見(jiàn)(2010)》指出：BMI≥27.5kg/m2的T2DM患者經(jīng)規(guī)范的非手術(shù)治療后效果不好或不能耐受時(shí),可考慮手術(shù)手術(shù)治療：對(duì)BMI27.5 kg/m2的T2DM患者手術(shù)僅作為臨床研究,不宜推廣。最近,我國(guó)剛發(fā)布了《中國(guó)肥胖和2型糖尿病外科治療指南(2014)》,其中指出：BMI≥32.5kg/m2的T2DM患者應(yīng)積極考慮手術(shù)；BMI 27.5kg/m2～32.5 kg/m2的T2DM患者,經(jīng)改變生活方式和藥物治療難以控制血糖且至少符合額外的2個(gè)代謝綜合征組分或存在合并癥,可考慮手術(shù)；對(duì)BMI 25.0kg/m2～27.5kg/m2的T2DM患者,應(yīng)慎重開(kāi)展手術(shù)。雖然,目前胃旁路術(shù)為代表的減重手術(shù)已廣泛地應(yīng)用于治療T2DM,但是,在治療T2DM的患者選擇上,仍存在爭(zhēng)議。特別是對(duì)BMI35kg/m2的T2DM患者是否能采取減重手術(shù)的治療爭(zhēng)議較大。我們總結(jié)了我們近幾年“腹腔鏡胃旁路術(shù)”治療T2DM臨床經(jīng)驗(yàn)的基礎(chǔ)上,對(duì)三組不同BMI患者胃旁路術(shù)后的臨床療效,進(jìn)行了初步的比較研究和探討,主要比較三組患者血糖控制率是否存在差異,探索不同BMI患者胃旁路術(shù)后降糖效果。目的不同體重指數(shù)的T2DM患者“腹腔鏡胃旁路術(shù)”的臨床療效。方法在我科2010-2013年間,實(shí)施“腹腔鏡胃旁路術(shù)”的206名2型糖尿病患者中,分層隨機(jī)抽取25kg/m2BMI28 kg/m2、28 kg/m2≤BMI35 kg/m2、35 kg/m2≤BMI三組各20例,共60名患者,分別作為低BMI組、中BMI組和高BMI組。三組患者均采用相同的全麻下“腹腔鏡胃旁路”術(shù)式。將糖化血紅蛋白7%定義為血糖控制。三組患者術(shù)后12個(gè)月血糖控制率以及術(shù)后體重、腰圍、臀圍、BMI、空腹血糖、餐后2小時(shí)血糖、空腹C肽、餐后2小時(shí)C肽、空腹胰島素、餐后2小時(shí)胰島素變化情況,及術(shù)后并發(fā)癥發(fā)生情況。統(tǒng)計(jì)方法：三組間術(shù)后12個(gè)月血糖控制率比較用x2檢驗(yàn)比較分析；組間術(shù)前指標(biāo)、術(shù)后12個(gè)月指標(biāo)及術(shù)前術(shù)后指標(biāo)變化值,采用多樣本均數(shù)的方差分析；組內(nèi)術(shù)前術(shù)后指標(biāo)比較采用配對(duì)t檢驗(yàn)。p值小于0.05為有統(tǒng)計(jì)學(xué)差異,采用雙側(cè)檢驗(yàn)。所用數(shù)據(jù)分析用統(tǒng)計(jì)軟件spss 13.0分析。結(jié)果低BMI組、中BMI組、高BMI組血糖控制率分別為75%、85%、90%,三組患者血糖控制率無(wú)統(tǒng)計(jì)學(xué)差異；三組患者體重、BMI、腰圍、臀圍、空腹血糖、餐后2小時(shí)血糖、術(shù)后12個(gè)月均較術(shù)前顯著改善,空腹胰島素、餐后2小時(shí)胰島素也較術(shù)前較少,高BMI組的空腹C肽、餐后2小時(shí)C肽也較術(shù)前明顯降低,但是低BMI和中BMI組,這兩項(xiàng)指標(biāo)較術(shù)前的變化不明顯：中、高BMI組各有兩例患者出現(xiàn)低血糖,三組各有2例出現(xiàn)胃腸吻合口潰瘍。結(jié)論腹腔鏡胃旁路術(shù)后,BMI 28-35kg/m2的T2DM患者,可能會(huì)取得與BMI35kg/m2患者大致相同的臨床療效,BMI 25-28kg/m2的T2DM患者,也可手術(shù)獲益,且可取得較為滿意的臨床治療效果,也不失為一種可供臨床治療選擇的方案之一。三組不同BMI的T2DM患者在腹腔鏡胃旁路術(shù)后均可獲得較為滿意的臨床療效。
[Abstract]:Background diabetes is a common group of metabolic disorders characterized by glucose and fat metabolism disorder and high plasma glucose level. Among them, T2DM (type 2 diabetes) is mainly due to insulin resistance combined with relative insulin deficiency. It is characterized by carbon hydrates, fat, protein, vitamins, water and electrolytes. Metabolic disorders. The incidence of diabetes in the world is increasing year by year. It is reported that the incidence of diabetes in adults aged 20 to 79 years old in 2010 is 6.4%. The influence of 285 million adults on.WHO survey shows that by 2030 the number of diabetes will double, and the new cases are mainly concentrated in the developing countries such as China and other developing countries in.2008 years. The prevalence rate of adults over 20 years old in China is 9.7%, and the total number of diseases is more than 90 million, of which T2DM accounts for the treatment of 90%. diabetes. It has been used for a long time, including health education, medical nutrition treatment, physical exercise, disease monitoring, oral medicine treatment, insulin treatment, GLP- 1 traditional treatments such as analogues and DPP IV inhibitors. Despite the staircase or intensive treatment of the above treatment, many patients are still difficult to achieve the desired target of treatment. The control of blood sugar is closely related to the reduction of diabetic complications. The complications of diabetes are very harmful to health. The harm of diabetes is not The acute complications of diabetes include diabetes ketoacidosis, hyperglycemic hyperosmotic state, diabetic ketoacidosis, hyperglycemic hyperosmotic state, and hyperglycemic hyperosmotic state two because of insulin relative deficiency and severe hyperemia. Two different metabolic disorders characterized by sugar. Hyperglycemic hyperosmotic state, due to insufficient insulin and high blood sugar, causes dehydration to cause severe dehydration. Diabetic ketoacidosis is a serious deficiency of insulin, severe hyperglycemia and dehydration, combined with the formation of ketone body and acid. Diabetes ketoacidosis, hyperglycemic hyperglycemia The death rate of diabetic ketoacidosis is almost 100%. before the discovery of insulin. Diabetes ketoacidosis is the main cause of death in adolescents with diabetes. The chronic complications of diabetes are the most serious harm to the human body, the disability and death of diabetes. The main causes of diabetes are coronary heart disease, cardiomyopathy, congestive heart failure, myocardial infarction, sudden death, ischemic or hemorrhagic cerebrovascular disease, cerebral atrophy, cerebral arteriosclerosis, renal arteriosclerosis, arteriosclerosis of limbs, and so on. Diabetic microvascular disease is a specific complication of diabetes and a typical change is microcirculation barrier Diabetic retinopathy and diabetic nephropathy can be caused by hindering and thickening of the microvascular basement membrane. After 20 years of diabetes, almost 100% of type 1 diabetes and 60% of type 2 diabetic patients have different degrees of retinopathy. Diabetic retinopathy is the main cause of loss of blindness in the United States. Diabetic nephropathy will shorten the patient's disease. Life expectancy affects patients' lifestyle and work. In most countries, diabetic nephropathy is the main cause of advanced kidney disease, the development of diabetic nephropathy to late stage, dialysis or renal transplantation, aggravating the patient and national economic burden, is an important cause of death in diabetes. Diabetic neuropathy can involve any part of the whole body nerve. It can cause abnormal sensation, pain, dull sensation, disappearance of feeling, disappearance of nerve reflex, muscle paralysis, muscle atrophy, changes of pupil, delayed gastric emptying, diarrhea, constipation, disappearance of light reflex, abnormal perspiration, erect hypotension, prolonged cardiac tachycardia, increased residual urine volume, urinary incontinence, urinary retention, sexual dysfunction, and so on. Urinary foot is a common chronic diabetic complication, which is associated with lower extremity neuropathy and peripheral vascular disease, infection and (or) deep tissue injury. The light is characterized by foot deformity, skin drying and hair cooling, and the weight of foot ulcers and gangrene. The article reports about 15% of diabetic patients in their lifetime. The stage of foot ulcer or gangrene, the amputation rate of type 2 diabetic patients is more than 17 times of non diabetic patients, diabetic foot is amputation, the main cause of disability. Diabetes patients are prone to infection, high infection rate, more serious infection and more difficult treatment. For example, patients can often have furuncle, carbuncle, immigrant or repeated occurrence. Real skin. Bacterial infection, such as tinea pedis, can also occur often, female patients can have fungal vaginitis and barbatitis. Patients with diabetes can also appear as Trichoderma, malignant otitis externa, emphysematous cholecystitis, emphysematous pyelonephritis and other uncommon infections. The incidence of tuberculosis in diabetic patients is 2.0-3.6 times higher than that of non diabetic patients, and the development of the disease is more than that of the non diabetic patients. In addition, diabetes can also cause various bone and joint lesions, skin lesions, and wound healing. Diabetes greatly threatens the health and social development of human beings. Diabetes has become one of the serious global public health problems. It has brought a heavy burden to the society and the economy for.1995 years, doctor Pories first reported and merged. T2DM obesity patients, after the implementation of the weight reduction "gastric bypass", not only achieved a significant "weight loss" effect, but also achieved a magical effect on diabetes "blood glucose control". From then on, people have seen new hopes for the treatment of T2DM. The treatment of T2DM, represented by "gastric bypass", should be done in the treatment of the disease. It is also flourishing and flourishing. Because of its excellent therapeutic effect on T2DM, weight reduction surgery has been recommended by experts and various guidelines as one of the treatment measures of T2DM standard. However, the current guidelines and consensus are mainly to use BMI as the main index for selecting patients and to consider the metabolic surgical treatment for T2DM patients with BMI > 35kg/m2. There is a basic consensus for treatment; however, there is still a dispute over the same treatment for this part of the BMI35kg/m2, but there is still a dispute.1991, NIH guidelines, and the first recommendation of the patient's BMI as the main indicator of the disease in the weight reduction operation under the condition that the clinical evidence is not sufficient. It is suggested that the obese patients with BMI40 kg/m2 are obese. People can choose weight reduction surgery; for patients with BMI in 35 kg/m2 to 40 kg/m2, if combined with high risk of cardiopulmonary problems, severe diabetes, or combined with physical problems affecting life, such as obesity related joint problems or the impact of occupational, family function, exercise, and so on, such patients may consider weight reduction surgery. Thereafter, guidelines And the formulation of the health agency statement is based on the standards of the NIH guide, and BMI is the primary standard for selecting patients.2009. ADA (American Diabetes Association) recommends that weight reduction surgery can be used for the treatment of T2DM for the first time. It points out that weight reduction treatment for T2DM patients with BMI > 35kg/m2 can be considered, especially those by changing lifestyle and drug treatment. Dissatisfied patients,.2011, IDF (International Diabetes Association) issued a statement that a weight-loss operation can be used as a treatment for T2DM patients with BMI > 35kg/m2; for BMI in 30kg/m2 to 35kg/m2 patients, the operation may be a kind of operation, especially when the best treatment effect is poor, especially in the combination of his cardiovascular risk factors. The choice of treatment. In our country, < surgical treatment for diabetes experts' consensus > and China's type 2 diabetes prevention guide (2010 Edition) > points out: (1) T2DM people with or without complications of BMI > 35 kg/m2 may consider weight reduction surgery; (2) people with BMI 30 kg/m2 to 35 kg/m2 and T2DM are difficult to control in lifestyle and drug treatment. When blood sugar or complication, especially with cardiovascular risk factors, surgery should be one of the options for treatment; (3) among people with BMI 28.0kg/m2 to 29.9kg/m2, if they merge with T2DM and have centripetal obesity (female waistline 85CM, male 90cm) and at least additional compliance with the standard of two metabolic syndrome (high triglyceride, low density lipoprotein bile solid) Alcohol, hypertension), weight loss surgery should also be considered as one of the choice of treatment; (4) BMI25.0kg/m2 ~ 27.9kg/m2 T2DM patients, the operation should be considered as an experimental study, and should not be widely popularized. < < Chinese Diabetes surgical treatment expert guidance (2010) > > point out: BMI > 27.5kg /m2 T2DM patients after standardized non-surgical treatment results are not good or In the case of intolerance, surgical treatment can be considered: the operation of T2DM patients with BMI27.5 kg/m2 is not suitable for clinical study. Recently, China has just published the guidelines for surgical treatment for obesity and type 2 diabetes in China (2014). It is pointed out that the T2DM patients with BMI > 32.5kg/m2 should consider the operation actively; BMI 27.5kg/m2 ~ 32.5 kg/m2 T2DM patients Patients who are difficult to control blood glucose by changing lifestyle and medications are difficult to control blood sugar and at least 2 additional metabolic syndrome components or concomitant symptoms. Surgery should be considered; surgery for BMI 25.0kg/m2 to 27.5kg/m2 T2DM patients should be carefully operated. Although the weight reduction surgery represented by gastric bypass has been widely used in the treatment of T2DM, however, however, There is still controversy in the choice of patients with T2DM, especially whether the T2DM patients in BMI35kg/m2 can take the treatment of weight reduction surgery. We summarized the clinical experience of laparoscopic gastric bypass for the treatment of T2DM in recent years, and made a preliminary comparison of the clinical efficacy of three groups of different BMI patients after the parastastal bypass. Compared with the study and discussion, the difference of blood glucose control rate between the three groups was compared, and the effect of hypoglycemic effect of different BMI patients after gastric bypass surgery was explored. The clinical efficacy of "laparoscopic gastric bypass" in T2DM patients with different body mass index (BMI) was performed in 206 cases of type 2 diabetic patients undergoing "abdominal endoscopic gastric bypass" in 2010-2013 years of our department. 20 cases of 25kg/m2BMI28 kg/m2,28 kg/m2 < BMI35 kg/m2,35 kg/m2 < BMI three were selected by stratified random sampling. A total of 60 patients were used as low BMI group, middle BMI group and high BMI group respectively. The three groups were treated with the same general anesthesia "laparoscopic gastric bypass" operation. The glycated hemoglobin 7% was defined as blood sugar control. The three groups of patients had 12 months of blood glucose after 12 months. Control rate, waist circumference, hip circumference, BMI, fasting blood glucose, 2 hours postprandial blood glucose, fasting C peptide, 2 hours postprandial C peptide, fasting insulin, 2 hours postprandial insulin changes and postoperative complications. Statistical methods: comparison and analysis of blood glucose control rate in the three groups after 12 months of operation were compared with x2 test; preoperative index and operation between groups After 12 months of the index and the preoperative and postoperative index changes, using the multiple sample mean variance analysis, the preoperative and postoperative indexes compared with the paired t test.P value less than 0.05 was statistically different, the use of bilateral test. Data analysis using statistical software SPSS 13 analysis. Results low BMI group, BMI group, high BMI group blood glucose control rate respectively The blood glucose control rates of the 75%, 85%, 90% and three groups were not statistically different. The three groups of patients weight, BMI, waistline, hip circumference, fasting blood glucose, 2 hours postprandial blood glucose, 12 months after the operation were significantly improved, fasting insulin and 2 hours postprandial insulin were less than before, higher BMI group C peptide, and 2 hours postprandial C peptide was also significantly lower than before the operation, In the low BMI and middle BMI group, the two indexes were not obvious before the operation. In the high BMI group, two patients had hypoglycemia and 2 of the three groups had gastrointestinal anastomosis ulcers. Conclusion after the laparoscopic gastric bypass, the T2DM patients of BMI 28-35kg/m2 may have approximately the same clinical efficacy as BMI35kg/m2 patients, BMI 25-28kg/m2 T2D. M patients also benefit from surgery, and can achieve satisfactory clinical therapeutic effects. It is also one of the options available for clinical treatment. Three groups of T2DM patients with different BMI can obtain satisfactory clinical efficacy after laparoscopic gastric bypass surgery.
【學(xué)位授予單位】：南方醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R587.1;R656.61

【參考文獻(xiàn)】

相關(guān)期刊論文 前2條

1 張玉新;吳良平;戴曉江;唐新智;康慧鑫;;腹腔鏡下胃轉(zhuǎn)流術(shù)治療2型糖尿病臨床療效評(píng)價(jià)[J];局解手術(shù)學(xué)雜志;2011年03期

2 徐定銀;金凱;錢(qián)建中;;胃旁路轉(zhuǎn)流術(shù)對(duì)實(shí)驗(yàn)性2型糖尿病大鼠胰島素抵抗的影響[J];中國(guó)現(xiàn)代醫(yī)生;2011年03期

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