【摘要】 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。

　　【关键词】 糖尿病，2型;腹腔镜Roux-en-Y胃旁路术;胃囊容积;腹型肥胖;胰岛素抵抗

　　Effects of LRYGB with different gastric pouch volume on type 2 diabetic patients with BMI <35 kg/m2 YI Bo，LI Peng-zhou，JIANG Juan，et al.Department of General Surgery，Third Xiangya Hospital，Changsha 410013，China

　　Corresponding author：ZHU Shai-hong，E-mail：zhushaihong@medmail.com.cn

　　【Abstract】 Objective To explore effects of LRYGB with different gastric pouch volume on type 2 diabetic patients with BMI <35 kg/m2. Methods 60 T2DM patients were recruited and randomized to 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 HbA1c，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 HOMA-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.

　　【Key words】 Diabetes mellitus，type 2;Laparoscopic Roux-en-Y gastric bypass (LRYGB);Stomach pouch;Abdominal visceral obesity;Insulin resistance(IR)