發(fā)布時間：2018-02-13 20:09

  本文關(guān)鍵詞： 腹腔鏡Roux-en-Y胃旁路術(shù) 腹腔鏡袖狀胃切除術(shù) 肥胖 2型糖尿病　出處：《吉林大學》2017年碩士論文　論文類型：學位論文

【摘要】：背景:肥胖癥已成為世界范圍內(nèi)流行的一種慢性病。伴隨著肥胖癥的發(fā)生,冠心病、高血壓、脂肪肝、阻塞性睡眠呼吸暫停綜合征等一系列代謝性疾病的發(fā)生率也不斷提高,其中以2型糖尿病與肥胖癥的關(guān)系最為密切。目前,減重代謝手術(shù)被認為是治療肥胖合并2型糖尿病最有效的手段。其中,腹腔鏡Roux-en-Y胃旁路術(shù)和袖狀胃切除術(shù)的應用最為廣泛。腹腔鏡袖狀胃切除術(shù)已由治療重度肥胖患者第一階段的術(shù)式轉(zhuǎn)為治療肥胖合并2型糖尿病的獨立術(shù)式,具有手術(shù)操作簡單,并發(fā)癥少等優(yōu)點。腹腔鏡Roux-en-Y胃旁路術(shù)的療效已得到人們的廣泛認可,被認為是減重代謝手術(shù)的標準術(shù)式。本研究總結(jié)了自2015年2月至2016年2月于我科進行減重代謝手術(shù)的52例患者資料,通過分析患者接受兩種術(shù)式前后血糖、血脂、體重及伴隨疾病的緩解情況,進一步對比兩種術(shù)式的臨床療效。目的:觀察肥胖合并2型糖尿病患者行腹腔鏡Roux-en-Y胃旁路術(shù)和袖狀胃切除術(shù)前后血糖、血脂、體重等相關(guān)代謝指標的變化,術(shù)后并發(fā)癥及2型糖尿病的緩解情況,并以此對兩種手術(shù)方式的可行性、安全性和有效性進行對比研究。方法:回顧性分析2015年2月至2016年2月期間于我科接受減重代謝手術(shù)的肥胖合并2型糖尿病的52名患者的臨床資料。按手術(shù)方式分為2組:LSG組和LRYGB組。其中LSG組患者29例,男性8例,女性21例,年齡(44±12)歲,體重(104.02±28.84)kg,BMI(36.37±7.83)kg/m2。LRYGB組患者23例,男性11例,女性12例,年齡(38±14)歲,體重(106.66±40.26)kg,BMI(37.28±14.31)kg/m2�；颊呷朐汉笮邢到y(tǒng)檢查,排除繼發(fā)性肥胖及手術(shù)禁忌癥后,在靜脈吸入復合麻醉下分別行LSG及LRYGB兩種手術(shù)方式。術(shù)后隨訪一年,觀察并記錄患者血糖、血脂、體重及相關(guān)代謝性疾病的緩解情況。各組數(shù)據(jù)采用SPSS19.0軟件進行統(tǒng)計分析,均以均數(shù)±標準差表示,P0.05有統(tǒng)計學意義。結(jié)果:52例手術(shù)均順利完成,無中轉(zhuǎn)開腹及死亡的病例。LSG組與LRYGB組手術(shù)時間分別為(93.70±9.96)、(104.43±15.51)min,術(shù)后住院時間為(5.30±1.51)、(6.41±2.32)d,兩組指標相比較,P值分別為0.000和0.031,均小于0.05。在術(shù)中出血量、術(shù)后排氣時間和術(shù)后進流食時間方面,兩組間比較差異無統(tǒng)計學意義。術(shù)后LSG組發(fā)生殘胃腔狹窄1例,LRYGB組發(fā)生殘胃出血1例,吻合口漏1例。兩組術(shù)后3月、6月、12月的體重、BMI、空腹血糖、餐后2h血糖、糖化血紅蛋白、空腹C肽、甘油三酯、膽固醇等代謝指標均較術(shù)前明顯改善(P0.05)。術(shù)后一年LSG組2型糖尿病的完全緩解率為79.3%,有效率為100%;LRYGB組完全緩解率與有效率分別為86.9%和100%。2組緩解率無明顯差別(P0.05)。結(jié)論:LSG與LRYGB兩種手術(shù)方式均可有效的改善患者血糖、血脂、體重等相關(guān)代謝指標,治療肥胖合并2型糖尿病,安全性及可行性較高,療效肯定。短期效果較顯著,長期效果仍有待研究。
[Abstract]:Background: obesity has become a worldwide epidemic chronic disease. With the occurrence of obesity, coronary heart disease, hypertension, fatty liver, obstructive sleep apnea syndrome and a series of metabolic diseases are also increasing. Among them, type 2 diabetes is most closely related to obesity. At present, weight-loss metabolic surgery is considered to be the most effective treatment for obesity with type 2 diabetes. Laparoscopic Roux-en-Y gastric bypass surgery and sleeve gastrectomy are the most widely used. Laparoscopic sleeve gastrectomy has changed from the first stage of treatment of severe obesity patients to the treatment of obesity with type 2 diabetes, the operation is simple. The efficacy of laparoscopic Roux-en-Y gastric bypass surgery has been widely recognized. This study summarized the data of 52 patients who underwent weight-loss metabolic surgery from February 2015 to February 2016, and analyzed the blood glucose and blood lipid of the patients before and after the two procedures. Objective: to observe the blood glucose and blood lipids before and after laparoscopic Roux-en-Y gastric bypass and sleeve gastrectomy in obese patients with type 2 diabetes. The changes of body weight and other related metabolic indexes, postoperative complications and the remission of type 2 diabetes mellitus, and the feasibility of the two surgical methods, Methods: the clinical data of 52 obese patients with type 2 diabetes undergoing weight-loss metabolic surgery from February 2015 to February 2016 were retrospectively analyzed. Two groups were divided into two groups: LSG group (n = 29) and LRYGB group (n = 29). Male 8, female 21, age 44 鹵12 years, body weight 104.02 鹵28.84 kg / kg BMIN 36.37 鹵7.83 kg / m ~ (2) LRYGB group 23 patients, male 11, female 12, age 38 鹵14), body weight 106.66 鹵40.26 kg BMIM 37.28 鹵14.31 kg 路m ~ (-2). The patients were followed up for one year to observe and record the remission of blood glucose, blood lipids, body weight and related metabolic diseases. The data of each group were analyzed by SPSS19.0 software. Results all 52 cases of operation were performed successfully. The operative time of LSG group and LRYGB group were 104.43 鹵15.51 min and 5.30 鹵1.51 鹵6.41 鹵2.32 days, respectively. The values of P were 0.000 and 0.031, respectively, which were less than 0.05.5.The blood loss, exhaust time and feeding time after operation were less than 0.05 in the two groups. There was no significant difference between the two groups. There were 1 case of residual gastric bleeding and 1 case of anastomotic leakage in the LSG group. The body weight of the two groups were measured on March, June and December, fasting blood glucose, 2 h postprandial blood glucose and glycosylated hemoglobin were found in the two groups. Fasting C-peptide, triglyceride, The complete remission rate of type 2 diabetes in the LSG group was 79.3, the effective rate was 86.9% and the effective rate in the 100g LRYGB group was 86.9% and 1000.There was no significant difference in the remission rate between the two groups (P0.050.Conclusion there is no significant difference in the remission rate between the two groups. Both LRYGB and LRYGB can improve blood glucose effectively. The treatment of obesity with type 2 diabetes is safe and feasible, and the curative effect is positive. The short-term effect is obvious, and the long-term effect is still to be studied.
【學位授予單位】：吉林大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R656.6;R589.2;R587.1

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