前瞻性对照研究腹腔镜袖状胃切除术对 2 型糖尿病肥胖患者小肠转运时间和胃排空半衰期的影响。
Prospective controlled study of effect of laparoscopic sleeve gastrectomy on small bowel transit time and gastric emptying half-time in morbidly obese patients with type 2 diabetes mellitus.
机构信息
Department of Surgery, Ruby Hall Clinic, Pune, India.
出版信息
Surg Obes Relat Dis. 2010 Mar 4;6(2):152-7. doi: 10.1016/j.soard.2009.11.019. Epub 2009 Dec 22.
BACKGROUND
Published data on sleeve gastrectomy (SG) have indicated better remission of type 2 diabetes mellitus (T2DM) and improvement in satiety compared with other restrictive procedures. Mechanisms in addition to rapid, extensive weight loss are responsible for the restoration of the euglycemic state. To prospectively evaluate the role of laparoscopic SG on gastric emptying half-time and small bowel transit time (SBTT) and effect of these on weight loss, satiety, and improvement in T2DM.
METHODS
A total of 67 subjects were studied. Of these 67 subjects, 24 were lean controls (body mass index 22.2 +/- 2.84 kg/m(2)), 20 were severely and morbidly obese patients with T2DM who had not undergone SG (body mass index 37.73 +/- 5.35 kg/m(2)), and 23 were severely and morbidly obese patients with T2DM after SG (body mass index 40.71 +/- 6.59 kg/m(2)). All 67 patients were evaluated for gastric emptying half-time and SBTT using scintigraphic imaging. Imaging was performed every 15 minutes up to the ileocecal region. The Three-Factor Eating Questionnaire was administered simultaneously. Fasting blood sugar, postprandial blood sugar, and glycated hemoglobin were assessed. Nonparametric analysis of variance and the Mann-Whitney U test were applied.
RESULTS
The mean SBTT was significantly lower (P <.05) in the post-SG group (199 +/- 65.7 minutes) than in the non-SG group (281.5 +/- 46.2 minutes) or control group (298.1 +/- 9.2 minutes). The gastric emptying half-time values were also significantly shorter (P <.05) in the post-SG (52.8 +/- 13.5 minutes) than in the non-SG (73.7 +/- 29.0 minutes) and control (72.8 +/- 29.6 minutes) groups. The glycated hemoglobin, fasting blood sugar, and postprandial sugar were all significantly lower after SG. The Three-Factor Eating Questionnaire findings revealed significantly earlier satiety (29.0 +/- 7.2) for the post-SG patients (P <.05) compared with the non-SG (45.8 +/- 9.0) and control (37.9 +/- 6.2) subjects.
CONCLUSION
A decreased gastric emptying half-time and SBTT after SG can possibly contribute to better glucose homeostasis in patients with T2DM.
背景
已发表的袖状胃切除术（SG）数据表明，与其他限制程序相比，SG 更能缓解 2 型糖尿病（T2DM）并改善饱腹感。除了快速、广泛的体重减轻外，还有其他机制负责恢复血糖正常状态。本研究前瞻性评估腹腔镜 SG 对胃排空半衰期和小肠转运时间（SBTT）的影响，并探讨这些因素对体重减轻、饱腹感和 T2DM 改善的影响。
方法
共纳入 67 例患者，其中 24 例为瘦对照组（体重指数 22.2 ± 2.84kg/m²），20 例为未经 SG 治疗的重度和极重度肥胖伴 T2DM 患者（体重指数 37.73 ± 5.35kg/m²），23 例为接受 SG 治疗的重度和极重度肥胖伴 T2DM 患者（体重指数 40.71 ± 6.59kg/m²）。所有 67 例患者均采用闪烁成像法评估胃排空半衰期和 SBTT。每隔 15 分钟进行一次成像，直到回盲部。同时进行三因素饮食问卷评估。检测空腹血糖、餐后血糖和糖化血红蛋白。采用非参数方差分析和曼-惠特尼 U 检验进行分析。
结果
SG 组的平均 SBTT（199 ± 65.7 分钟）明显低于非 SG 组（281.5 ± 46.2 分钟）和对照组（298.1 ± 9.2 分钟）（P<.05）。SG 组的胃排空半衰期值也明显短于非 SG 组（52.8 ± 13.5 分钟）和对照组（72.8 ± 29.6 分钟）（P<.05）。SG 后糖化血红蛋白、空腹血糖和餐后血糖均明显降低。三因素饮食问卷结果显示，SG 组患者的饱腹感明显较早（29.0 ± 7.2）（P<.05），而非 SG 组（45.8 ± 9.0）和对照组（37.9 ± 6.2）患者的饱腹感较晚。
结论
SG 后胃排空半衰期和 SBTT 缩短可能有助于改善 T2DM 患者的血糖稳态。
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