目的：探讨不同胃囊容积腹腔镜 Roux‐en‐Y 胃旁路术（LRYGB）对BMI ＜35 kg／m2的T2DM患者的术后疗效。方法60例T2DM患者分别行保留大部分胃囊的腹腔镜Roux‐en‐Y胃旁路术（下称“大胃囊LRYGB”）和缩小胃囊容积的改良LRYGB（下称“小胃囊LRYGB”，胃囊容积控制约50 ml）。患者术后随访12个月，比较两组手术前后BMI 、WC、体脂率、FPG、2 hPG、HbA1c、胰岛素抵抗指数（HOMA‐IR）变化及术后并发症发生率。结果两种手术方式均能降低 FPG、2 hPG、HbA1c水平，改善IR；小胃囊LRYGB对于BMI、体脂率、WC、术后吻合口溃疡发生率、糖代谢异常及IR的改善优于大胃囊LRYGB。结论两种手术方式均可缓解BMI＜35 kg／m2的 T2DM 患者糖代谢异常。相比大胃囊LRYGB ，小胃囊LRYGB更能改善腹型肥胖，且对糖代谢异常、IR的治疗优势更加明显。%Objective To explore effects of LRYGB with different gastric pouch volume on type 2diabeticpatientswithBMI<35kg/m2.Methods 60T2DMpatientswererecruitedandrandomizedto undergo either LRYGB with a big gastric pouch or LRYGB with a small gastric pouch (about 50 ml). All patients were followed up for 12 months. Pre‐and post‐operative changes in BMI ,waist circumference , body fat rate ,FPG ,2 hPG ,HbA1c ,HOMA‐IR and incidence of post‐operative complication were compared between the two groups. Results Both procedures were successful in reducing FPG ,2 hPG and HbA1 c , and improving HOMA‐IR. LRYGB with a small gastric pouch resulted in a greater reduction in BMI ,body fat rate ,WC ,incidence of postoperative marginal ulcer ,glucose metabolism disorders and HOM A‐IR compared with LRYGB with a big gastric pouch. Conclusion Both procedures are effective in treating glucose metabolism disorders for T2DM patients with BMI < 35 kg/m2. LRYGB with a small gastric pouch is better in releasing abdominal obesity ,restoring glucose metabolism disorders and improving IR.
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