单吻合口十二指肠回肠旁路联合袖状胃切除术对中国肥胖型2型糖尿病患者的疗效
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吉林大学中日联谊医院 减重与代谢外科,吉林 长春 130033

作者简介:

王泽雨,吉林大学中日联谊医院硕士研究生,主要从事减重代谢外科方面的研究。

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姜涛,Email: jiangtao99@jlu.edu.cn

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Efficacy of single-anastomosis duodenal-ileal bypass with sleeve gastrectomy in treatment of obese type 2 diabetes patients in China
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Department of Bariatric and Metabolic Surgery, China-Japan Union Hospital, Jilin University, Changchun 130033, China

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    摘要:

    背景与目的 在众多减重代谢手术中,单吻合口十二指肠回肠旁路联合袖状胃切除术(SADI-S)是治疗肥胖型2型糖尿病最有效的术式之一。但目前国内有关SADI-S的报道较少,本次研究探讨SADI-S对中国肥胖型2型糖尿病患者的疗效,以期为今后临床治疗的选择提供参考。方法 回顾性分析2018年10月—2021年8月期间在吉林大学中日联谊医院接受SADI-S治疗的50例肥胖型2型糖尿病患者的临床资料。分析患者术中及术后情况(手术时间、术后住院时间及手术并发症)、术后体质量、体质量指数(BMI)、多余体质量减少率(%EWL)、总体质量减少率(%TWL)、空腹血糖、糖化血红蛋白、糖尿病完全缓解率等指标的变化。随访时间截至2022年8月。结果 50例患者中,男24例,女26例;平均年龄34(28~43)岁。所有患者均通过腹腔镜(11例)或达芬奇机器人(39例)顺利完成SADI-S手术,无中转开腹及死亡病例。手术时间为(187.9±37.9)min,术后住院时长为6(6~7)d。手术并发症共3例(6%),其中,Clavien-Dindo Ⅱ级患者2例(分别为腹腔积液及吻合口瘘);Clavien-Dindo Ⅲ级患者1例(胃瘘)。吻合口瘘患者通过禁食、禁饮、全静脉营养及静脉应用抗生素等综合保守治疗后痊愈出院;胃瘘患者则通过胃瘘修补术治疗后痊愈出院。患者术后3、6、12、24个月体质量、BMI、空腹血糖及糖化血红蛋白均较术前明显下降(均P<0.05)。术后3、6、12、24个月%EWL分别为(57.8±17.5)%、(78.3±18.6)%、(97.3±22.1)%、(92.5±9.9)%;%TWL分别为23.2(19.9~25.9)%、31.9(29.3~33.7)%、39.3(34.7~45.2)%、43.0(39.1~47.1)%;2型糖尿病完全缓解率分别为82.0%(41/50)、95.7%(45/47)、100%(36/36)、100%(8/8)。术后3、6个月时,SADI-S对高ABCD评分患者糖尿病的治疗效果优于低ABCD评分患者,而在术后12、24个月时,SADI-S对各级ABCD评分患者的糖尿病治疗效果均显著。结论 SADI-S对中国肥胖型2型糖尿病患者具有显著的疗效,但其长期疗效仍需进一步随访观察。

    Abstract:

    Background and Aims Among many bariatric-metabolic procedures, the single-anastomosis duodenal-ileal bypass with sleeve gastrectomy (SADI-S) is one of the most effective treatments for obese type 2 diabetes. However, there are few reports on SADI-S in China. Therefore, this study was conducted to investigate the efficacy of SADI-S in obese type 2 diabetes patients in China to provide a reference for future treatment choices.Methods The clinical data of 50 patients with obese type 2 diabetes undergoing SADI-S at China-Japan Union Hospital of Jilin University between October 2018 and August 2021 were retrospectively analyzed. Patients were analyzed for intraoperative and postoperative conditions (operative time, postoperative hospital stay and surgical complications), weight, body mass index (BMI), extra weight loss (%EWL), total weight loss (%TWL), fasting glucose, glycosylated hemoglobin, and complete remission rate of diabetes after surgery. Follow-up was completed as of August 2022.Results Of the 50 patients, 24 cases were males and 26 cases were females, with a mean age of 34 (28-43) years. All patients completed SADI-S surgery by laparoscopic (11 cases) or robotic (39 cases) approach without conversion to laparotomy, and no death occurred. The operative time was (187.9±37.9) min and the length of postoperative hospital stay was 6 (6-7) d. Surgical complications occurred in 3 patients (6%), which included two Clavien-Dindo Grade Ⅱ complications (abdominal fluid collections and anastomotic leakage) and one Clavien-Dindo grade Ⅲ complication (gastric leakage). The patient with anastomotic leakage was discharged after a combination of conservative treatments, including water fasting, total intravenous nutrition, and intravenous antibiotic therapy. The patient with gastric leakage was discharged after treatment with gastric fistula repair. The patients' weight, BMI, fasting glucose and glycosylated hemoglobin decreased significantly at 3, 6, 12 and 24 months after surgery compared with their preoperative values (all P<0.05). The %EWL values were (57.8±17.5)%, (78.3±18.6)%, (97.3±22.1)%, and (92.5±9.9)%, the %TWL values were 23.2 (19.9-25.9)%, 31.9 (29.3-33.7)%, 39.3 (34.7-45.2)%, 43.0 (39.1-47.1)% and the complete remission rates of type 2 diabetes were 82.0% (41/50), 95.7% (45/47), 100% (36/36), and 100% (8/8) respectively at 3, 6, 12, and 24 months after surgery. SADI-S yielded better efficacy against diabetes in patients with high ABCD scores than those with low ABCD scores at 3 and 6 months after surgery, and yielded remarkable efficacy against diabetes in patients with ABCD scores of all levels.Conclusion SADI-S has an excellent effect in treating obese type 2 diabetes in the Chinese population, but its long-term impact needs to be further observed.

    图1 SADI-S手术示意图Fig.1 Surgical diagram for SADI-S
    图2 SADI-S术后减重指标的变化趋势 A:%EWL;B:%TWLFig.2 The changing trends of weight-loss variables after SADI-S A: %EWL; B: %TWL
    图3 不同ABCD评分患者在各随访时间点的糖尿病完全缓解率Fig.3 Complete remission rates in patients with different ABCD scores at each follow-up time
    图1 SADI-S手术示意图Fig.1 Surgical diagram for SADI-S
    图2 SADI-S术后减重指标的变化趋势 A:%EWL;B:%TWLFig.2 The changing trends of weight-loss variables after SADI-S A: %EWL; B: %TWL
    图3 不同ABCD评分患者在各随访时间点的糖尿病完全缓解率Fig.3 Complete remission rates in patients with different ABCD scores at each follow-up time
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王泽雨,王伦,赵玉会,贾永恒,马巍岐,姜涛.单吻合口十二指肠回肠旁路联合袖状胃切除术对中国肥胖型2型糖尿病患者的疗效[J].中国普通外科杂志,2022,31(10):1339-1346.
DOI:10.7659/j. issn.1005-6947.2022.10.009

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  • 收稿日期:2022-08-21
  • 最后修改日期:2022-09-28
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  • 在线发布日期: 2022-10-31