Objective: To compare the 1-year effects of Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy with Roux-en-Y duodenal bypass (SG+RYDJB) on weight loss, remission of diabetes, and postoperative complications in patients with obesity and type 2 diabetes. Methods: A single-center retrospective cohort study was conducted at the First Affiliated Hospital of Nanjing Medical University from January 2020 to December 2020. Sixty-four patients with type 2 diabetes and body mass index (BMI) of 27.5-40.0 kg/m2 were included in this study and divided into the RYGB group (n=34) and the SG+RYDJB group (n=30). In both procedures, the biliopancreatic branch was measured 100 cm distal to the Treitz ligament, and the food branch was measured 100 cm distal to the gastric or duodenojejunal anastomosis. Patients were followed up by telephone or WeChat, a free messaging and calling app at 1, 3, 6, and 12 months postoperatively to determine their weight loss and remission of diabetes. The primary outcomes were the weight loss and reduction in blood glucose concentrations at 1 year after surgery and postoperative complications. Other postoperative changes, including body weight, BMI, percentage of total weight loss (%TWL), percentage of excess weight loss (%EWL), glycated hemoglobin A1c (HbA1c), and fasting blood glucose at 1 year after surgery were also assessed. Results: There were no significant differences in baseline data between the two groups (all P>0.05). No conversion to open surgery or death occurred in either group. Operation time was longer in the SG+RYDJB than the RYGB group (137.8±22.1 minutes vs. 80.0±24.9 minutes, t=9.779, P<0.001) and the incidence of perioperative complications was higher in the SG+RYDJB than the RYGB group (20% [6/30] vs. 2.9% [1/34], χ2=4.761, P=0.029). However, the postoperative hospital stay was similar between the two groups [3.0 (3.0, 4.3) days vs. 3.0 (4.0, 6.0) days, U=641.500, P=0.071]. Perioperative complications comprised small gastric pouch anastomotic leakage in one patient in the RYGB group and leakage (three patients) and bleeding (two patients with gastrointestinal bleeding and one with trocar site bleeding) in the SG+RYDJB group. Long-term complications were as follows. The incidence of anemia was significantly higher in the RYGB than the SG+RYDJB group (26.5% [9/34] vs. 3.3% [1/30], χ2=6.472, P=0.011). However, there were no significant differences in incidences of postoperative reflux, dumping syndrome, alopecia, diarrhea, constipation or foul-smelling flatus between the two groups (all P>0.05). Compared with 1 year before surgery, the body weights and fasting plasma glucose concentrations of patients in the SG+RYDJB and RYGB group (72.4±10.6 kg vs. 98.5±14.2 kg, respectively; 68.2±10.0 kg vs. 91.9±14.8 kg, respectively), BMI (25.2±2.9 kg/m2 vs. 34.3±4.2 kg/m2, respectively; 24.3±2.4 kg/m2 vs. 32.7±3.7 kg/m2, respectively) (5.5±1.6 vs. 10.6±3.3, respectively; 5.8±2.1 vs. 9.0±3.4, respectively); HbA1c (5.7±0.8 vs. 9.7±1.2, respectively; 9.1±1.9 vs. 5.9±0.9, respectively) were significantly lower at 1 year after surgery (all P<0.05). However, the % TWL (26.5%±6.0% vs. 25.6%±4.4%, t=0.663, P=0.510) and % EWL (109.1%±38.2% vs. 109.4%±40.3%, t=-0.026, P=0.026), rate of complete remission of diabetes at 1 year (80.0% [24/30] vs. 82.4% [28/34], χ2=0.058, P=0.810] did not differ significantly between the two groups (all P>0.05). Conclusions: Although SG+RYDJB surgery compared with RYGB is more difficult to perform, it can achieve similar weight loss and remission of diabetes and is associated with a lower incidence of anemia because of the preservation of the pylorus.
目的： 比较肥胖合并2型糖尿病患者胃旁路术（RYGB）与袖状胃切除加十二指肠旁路术（SG+RYDJB）后减重降糖以及术后近远期并发症发生情况，分析两种手术的应用价值。 方法： 采用回顾性队列研究方法，回顾性分析2020年1至12月期间，在南京医科大学第一附属医院减重代谢外科接受RYGB或SG+RYDJB，体质指数（BMI）为27.5~40.0 kg/m2的2型糖尿病患者临床资料，这两种术式在术中均从距屈氏韧带远端测量100 cm作为胆胰支，从胃或十二指肠空肠吻合口处远端测量100 cm作为食物支。纳入RYGB组34例，SG+RYDJB组30例；两组患者性别、年龄，术前体质量、BMI、糖尿病病程、空腹血糖和糖化血红蛋白比较，差异无统计学意义（均P>0.05），组间具有可比性。对患者术后1、3、6和12个月进行电话或微信随访，主要比较患者术后1年的减重降糖效果以及术后近远期并发症，具体包括：术后1年体质量、BMI、总体质量减少百分比（%TWL）、多余体质量减少百分比（%EWL）、糖化血红蛋白、空腹血糖和术后并发症。 结果： 两组均无中转开腹和死亡病例。SG+RYDJB组较RYGB组手术时间更长［（137.8±22.1）min比（80.0±24.9）min，t=9.779，P<0.001］、围手术期并发症发生率更高［20.0%（6/30）比2.9%（1/34），χ2=4.761，P=0.029］，但两组术后住院时间相当［3.0（3.0，4.3）d比3.0（4.0，6.0）d，U=641.500，P=0.071］。在围手术期并发症方面，RYGB组仅发生1例小胃囊吻合口漏；SG+RYDJB组发生3例吻合口漏、3例出血（2例消化道出血、1例穿刺孔出血）。在远期并发症方面，RYGB组贫血发生率明显高于SG+RYDJB组［26.5%（9/34）比3.3%（1/30），χ2=6.472，P=0.011］，但两组术后的胃食管反流、倾倒综合征、脱发、腹泻、便秘、排臭气等方面比较差异均无统计学意义（均P>0.05）。与术前比较，SG+RYDJB组和RYGB组患者术后1年的体质量均下降［分别为（72.4±10.6）kg比（98.5±14.2）kg；（68.2±10.0）kg比（91.9±14.8）kg］、BMI下降［（25.2±2.9）kg/m2比（34.3±4.2）kg/m2；（24.3±2.4）kg/m2比（32.7±3.7）kg/m2］、空腹血糖下降［（5.5±1.6）mmol/L比（10.6±3.3）mmol/L；（5.8±2.1）mmol/L比（9.0±3.4）mmol/L］和糖化血红蛋白下降［（5.7±0.8）%比（9.7±1.2）%；（5.9±0.9）%比（9.1±1.9）%］比较，差异均有统计学意义（均P<0.05）。但SG+RYDJB组与RYGB组术后1年%TWL［（26.5±6.0）%比（25.6±4.4）%，t=0.663，P=0.510］、%EWL［（109.1±38.2）%比（109.4±40.3）%，t=-0.026，P=0.979］、1年糖尿病完全缓解率［80.0%（24/30）比82.4%（28/34），χ2=0.058，P=0.810］比较，差异无统计学意义（均P>0.05）。 结论： SG+RYDJB手术难度较大，相较RYGB，SG+RYDJB可获得类似的减重降糖效果，且术后保留了幽门，贫血发生率更低。.