非肥胖性2型糖尿病行腹腔镜胃转流术可行性及疗效研究word论文.docxVIP

摘要目 的 探讨腹腔镜胃转流术治疗非肥胖性 2 型糖尿病的可行性及有效性。方 法 根据纳入和剔除标准筛选 16 例 2 型糖尿病患者，采用腹腔镜下胃转流术治疗。根据 患者体重指数（Body mass index,BMI）把 2 型糖尿病分为两组：A 组不合并肥胖（BMI30 kg/ m2）共 8 人，B 组合并肥胖（BMI＞30 kg/ m2）共 8 人，这两组病人 都通过相同的胃转流术，即腹腔镜下用闭合器在近胃端分出一个小的胃囊 100ml 左 右,距离 Trietz 韧带 100cm 左右处切断空肠,然后将远端空肠与小胃吻合,残端闭合器 闭合，再在距此吻合口 100cm 左右作肠空肠端侧吻合,形成 Roux-en -Y 胃转流术。 通过比较 A 组，B 组的术前和术后 2 个月糖尿病相关指标（空腹血糖、糖耐量实验、 糖化血红蛋白、C 肽、血清胰岛素），评价胃转流术对于 2 型糖尿病的临床疗效，得 出两组治疗的有效率，然后再比较有效率有无差别。结 果(1)16 例患者手术后 2 月与手术前对照，口服糖耐量试验（OGTT）各时相血糖值均较术前下降，术后糖 化血红蛋白较术前下降，说明术后 2 月患者血糖代谢较术前明显好转。C 肽、胰岛 素刺激释放试验结果显示，术后 C 肽、胰岛素基础分泌及刺激分泌值较术前均有升 高。说明胰岛素功能在增强。 (2) 16 例患者随访期间，术后 l 例发生粘连性肠梗阻；2 例发生营养不良，低铁血症；无死亡病例发生；结 论 (1) 腹腔镜下胃转流术治疗肥胖合并 2 型糖尿病的病人有效，患者血糖代谢明显改善，同时胰岛素，糖化血 红蛋白及 C 肽均有改善。（2） 该手术也是非肥胖型 2 型糖尿病的一种有效治疗方 式。(3) 腹腔镜下胃转流术对 2 型糖尿病患者具有较高的安全性。（4）手术在治疗 2型糖尿病方面，治疗合并肥胖的 2 型糖尿病的效果要优于非肥胖性 2 型糖尿病的效 果。关键词：腹腔镜；胃转流术；非肥胖性 2 型糖尿病；1TheAnalysisoftheFeasibilityandCurativeEffect about LRYGB on Non-obese type 2 diabetesAbstractObjective To observe the effect and feasibility of laparoscopic gastric bypass operation on non-obese type diabetes patients. Method According to the inclusion and exclusion criteria, 16 cases of patients with type 2 diabetes were selected and accepted laparoscopic gastric bypass treatment. According to BMI the patients with type 2 diabetes were divided into two groups: Group A, 8 patients without obesity ( BMI 30 kg/m2 )and Group B, 8 with obesity ( BMI ＞ 30 kg/m2 ) . Two groups of patients got the samegastric bypass surgeries. Namely a gastric pouch about 100ml from proximal gastric was separated with closure devices and the jejunum was cut off at around 100cm from Trietz ligament. And the anastomosis was adopted between distal jejunum and the small gastric pouch mentioned above. Then intestinal jejunostomy was carried out at around 100cm from the first stoma so that the Roux-en -Y gastric bypass was formed. By comparing the relative diabetic indexes of Group A and B (fasting blood glucose, Oral glucose tolerance test ,glycosylated hemoglobin, C