腹腔镜手术治疗胆囊结石合并低体质量指数2型糖尿病
安东均 郑晓燕 安琳 张成 王羊
摘 要
目的：探讨腹腔镜手术同期治疗胆囊结石合并低体质量指数（body mass index，BMI）2型糖尿病（type 2 diabetes mellitus，T2DM）的临床疗效。
方法：回顾性分析2012年5月～2015年6月对75例胆囊结石合并T2DM患者行腹腔镜胆囊切除手术（laparoscopic cholecystectomy，LC）同期对BMI≥28 kg/m2的39例（A组）施行腹腔镜胃旁路术（Laparoscopic Roux-en-Y gastric bypass，LRYGB）和BMI＜28 kg/m2（B组）的36例行腹腔镜空回肠转流术（laparoscopic jejunoileal bypass，LJIB）的临床资料。
结果：75例患者均成功完成手术，无围手术期死亡，术后随访1年。2组患者治愈率分别为84.6%和88.9%，差异无统计学意义（x2=0.053，P＞0.05）。2组患者手术时间、术后住院时间、住院总费用、手术并发症等指标比较差异有统计学意义（分别t=3.513，2.188，2.656，x2=6.351，均P＜0.05）。术后3、6、12个月 A 组患者BMI持续下降（分别t=3.251，2.348，4.581，均 P＜0.05），而B 组无明显变化（分别t=1.644，-0.045，2.124，均 P＞0.05）。2组患者BMI比较，差异有统计学意义（F=2.32，P＜0.05）。
结论：胆囊结石合并T2DM患者施行LC的同时对低BMI患者选用LJIB手术，医疗费用低，治疗效果好。
关键词
胆囊结石病；腹腔镜；糖尿病，2型；胃旁路术；空回肠转流术
One stage laparoscopic therapy for gallbladder stones and type 2 diabetes of low body mass index
AN Dongjun，ZHENG Xiaoyan，AN Lin，ZHANG Cheng，WANG Yang.Department of Hepatobiliary Surgery，Xianyang Central Hospital，Xianyang 712000，China
Corresponding author:AN Dongjun，Email:1158011981@qq.con
ABSTRACT
Objective:To explore the clinical efficacy of laparoscopic surgery for gallbladder stones with type 2 diabetes（T2 DM）patients of low body mass index（BMI）.
Methods:The clinical data of 75 patients who received laparoscopic cholecystectomy and bypass procedure for gallstones with T2DM from May 2012 to June 2015 were retrospectively analyzed.Laparoscopic Roux-en-Y gastric bypass surgery was completed in 39 cases（BMI≥28 kg/m2，group A）and laparoscopic jejunoileal bypass in 36 cases（BMI＜28 kg/m2，group B）.
Results:75 patients were successfully completed surgery.There were no perioperative death.all patients were followed-up for 1 year after surgery.The cure rate were 84.6%and 88.9%respectively（x2=0.053，P＞0.05）.Between the two groups operation time，postoperative length of hospital stay，total hospitalization expenses and surgical complications were statistically different（respectively t=-2.513，2.188，2.656，x2=6.351，all P＜0.05）.Postoperative 3，6 and 12 months BMI declines in group A patients（respectively t=3.251，2.348，4.581，all P＜0.05），while there was no statistical difference in group B patients（respectively t=1.644，-0.045，2.124，all P＞0.05）.BM 1 was statistically different between the two groups（F=2.32，P＜0.05）.
Conclusion:In patients with gallbladder stones and T2DM，LC andLJIB in low BMI patients can achieve excellent results with low costs.
KEY WORDS
cholecystolithiasis；Laparoscope；Diabetes mellitus，type 2；Gastric bypass；Jejunal ileal bypass
近年来我国2型糖尿病与胆囊结石的发病呈结伴而行的态势。我们对75例胆囊结石合并2型糖尿病患者。在腹腔镜胆囊切除同期依据其体质量指数高低分别施行胃旁路手术或空回肠转流手术治疗，现将临床疗效报道如下。