【提要】 代谢手术治疗肥胖和T2DM已成为内外科的共识，代谢手术的概念已逐渐代替原减重手术的名称。代谢手术目前主要有腹腔镜Roux-en-Y胃旁路术(LRYGB)、腹腔镜袖状胃切除术(LSG)、腹腔镜可调节胃束带术(LAGB)及腹腔镜胆胰转流术或腹腔镜胆胰转流术+十二指肠转位术(LBPD或LBPD-DS)。从目前的文献证据来看，减重降糖效果最好的是LBPD或LBPD-DS，其次是LRYGB，最差的是LAGB。短期的随访结果表明，LSG和LRYGB减重及降糖效果相当，但随机对照研究表明，LRYGB降糖效果优于LSG。LBPD或LBPD-DS术后营养并发症发生率较高。对于T2DM手术缓解率的预测因素除术式外，还有糖尿病病程，C-P等。

　　【关键词】 肥胖;糖尿病，2型;减重手术;代谢手术;缓解率

　　Comparison of metabolic surgery procedures for obesity and type 2 diabetes mellitus LIANG Hui，ZHOU Hong-wen，GUAN Wei，et al.Bariatric and Metabolic Surgery，The First Affiliated Hospital with Nanjing Medical University，Nanjing 210029，China

　　【Abstract】 Surgical treatment for obesity and type 2 diabetes (T2DM)has recently been accepted by physicians and surgeons. The concept of metabolic surgery has gradually replaced bariatric surgery. The main patterns of metabolic surgery include: laparoscopic Roux-en-Y gastric bypass (LRYGB)，sleeve gastrectomy (LSG)，adjustable gastric banding (LAGB) and biliopancreatic diversion(LBPD) or LBPD + duodenal switch(DS). The current literatures showed that LBPD or LBPD-DS is the most effective procedure for weight loss and diabetes remission，followed by LRYGB，and LAGB as the least. The short-term follow-up Results showed that LSG and LRYGB have the same effects on weight loss and diabetes remission，but randomly controlled studies showed that LRYGB is more effective than LSG on diabetes remission. However，the rate of nutrition related complications after LBPD or LBPD-DS is relatively high than other three patterns. Predictive factors for T2DM remission by surgery include duration of diabetes and C-peptide level besides the operation pattern.

　　【Key words】 Obesity;Diabetes mellitus，type 2;Bariatric surgery;Metabolic surgery;Remission rate