联合手术治疗胆囊结石合并2型糖尿病55例
安东均，安琳，王治全，张成，马富平
摘 要
目的：探讨采用胆囊切除加Y型胃肠短路联合手术治疗胆囊结石合并2型糖尿病（T2DM）的临床疗效。
方法：对2008年5月～2010年6月间收治的55例胆囊结石合并T2DM分别采用开腹或腹腔镜胆囊切除联合Roux-en-Y型胃肠短路术，随访1年，分析其临床资料包括手术前后体质指数（BMI），空腹血糖水平（FBG），空腹胰岛素水平（FINS），胰岛素功能指数（HOMA-IR），糖化血红蛋白（HbA1c）的变化及术后1年糖尿病转归情况。
结果：胆囊结石55例全部治愈。I，II组患者术后BMI较术前无明显变化（P＞0.05）；全组患者从术后1个月开始空腹血糖水平即出现持续而稳定下降的趋势（P＜0.05）；伴随着术后血糖水平及胰岛素功能指数的改善，糖化血红蛋白亦出现明显下降（P＜0.05）。
结论：胆囊切除术联合Roux-en-Y型胃肠短路术除可治愈胆囊结石外，对2型糖尿病也具较好的疗效。
关键词
糖尿病，2型/外科学；胆囊结石/外科学；联合手术；胃肠短路术；腹腔镜手术
Combined surgical treatment of gallbladder stones with concomitant type 2 diabetes mellitus:a report of 55 cases
AN Dongjun，AN Lin，WANG Zhiquan，ZHANG Cheng，MA Fuping
ABSTRACT
Objective:To explore the clinical efficacy of cholecystectomy plus Roux-en-Y gastric bypass operation on cholecystolithiasis patients with concomitant type 2 diabetes mellitus（T2 DM）.
Methods:Fifty-five cholecystolithiasis patients with concomitant T2 DM，who were hospitalized from May 2008 to June 2010，underwent open or laparoscopic cholecystectomy combined with Roux-en-Y gastrojejunal bypass operation.All patients were followed up for one year period and their clinical data that included body mass index（BMI），fasting blood glucose（FBG），fasting serum insulin（FINS），homeostasis model assessment of insulin resistance（ HOMA-IR）and glycosylated hemoglobin（ HbAl c）before and after surgery as well as outcomes of the diabetes were analyzed.
Results:All 55 patients were cured of cholecystolithiasis.Of the patients，no significant changes were noted between the BMI values before and after operation（P＞0.05）；at the first month after surgery，the FBG level showed a sustained and steadily descending trend（P＜0.05）；mean while，HbA1 c level also decreased significantly（P＜0.05）with the postoperative glucose level and HOMA-IR was remarkably improved.
Conclusion:The combined procedures of cholecystectomy and Roux-en-Y gastrojejunal bypass operation not only cures cholecystolithiasis，but also has beneficial effects on T2DM.
KEY WORDS
Diabetes Mellitus，Type 2/surg；Cholecystolithiasis/surg；Combination Surgery；Gastrojejunal Bypass Operation；Laparoscopic Surgery
据报道，我国2型糖尿病（type 2 diabetes mellitus，T2DM）患者胆囊结石患病率为28.7%～32.6%，胆囊结石合并T2DM患者为16.9%［1］。笔者对2008年5月～2010年6月收治的合并胆囊结石的T2DM患者采用开腹或腹腔镜胆囊切除加Roux-en-Y型胃短路术共治疗55例，企以在行胆结石一次手术中同期治愈其T2DM，现报告如下。