asurgeryАмбулаторная хирургияAmbulatornaya khirurgiya = Ambulatory Surgery (Russia)2712-87412782-2591ООО «ГРУППА РЕМЕДИУМ»10.21518/1995-1477-2022-19-2-142-151asurgery-319Research ArticleОБМЕН ОПЫТОМEXCHANGE OF EXPERIENCE | PRACTICEРиски развития саркопении после бариатрических операций у пациентов с сахарным диабетом 2-го типаRisk of sarcopenia after bariatric surgery in patients with type 2 diabetes mellitushttps://orcid.org/0000-0002-2108-2362ХитарьянА. Г.KhitaryanA. G.

Хитарьян Александр Георгиевич - доктор медицинских наук, профессор, заведующий кафедрой хирургических болезней №3, Ростовский ГМУ; заведующий хирургическим отделением, КБ «РЖД-Медицина» г. Ростова-на-Дону.

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Aleksandr G. Khitaryan - Dr. Sci. (Med.), Professor, Head of the Department of Surgical Diseases No. 3, Rostov SMU; Head of the Surgical Department, CHR Railway-Medicine Rostovon-Don

29, Nakhichevansky Lane, Rostov-on-Don, 344022; 92a, Varfolomeeva St., Rostov-on-Don, 344011

khitaryan@gmail.comhttps://orcid.org/0000-0002-3127-9935АбовянА. А.AbovyanA. A.

Абовян Арутюн Араратович, аспирант кафедры хирургических болезней №3.

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Arutyun A. Abovyan - Рostgraduate Student of the Department of Surgical Diseases No. 3, Rostov SMU.

29, Nakhichevansky Lane, Rostov-on-Don, 344022

abovyan97@mail.ruhttps://orcid.org/0000-0001-7787-4919МежунцА. В.MezhuntsA. V.

Межунц Арут Ваграмович - кандидат медицинских наук, ассистент кафедры хирургических болезней №3, Ростовский ГМУ; врач-хирург хирургического отделения, КБ «РЖД-Медицина» г. Ростова-на-Дону.

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Arut V. Mezhunts - Cand. Sci. (Med.), Assistant of the Department of Surgical Diseases No. 3, Rostov SMU; Surgeon of the Surgical Department, CHR Railway-Medicine Rostov-on-Don

29, Nakhichevansky Lane, Rostov-on-Don, 344022; 92a, Varfolomeev St., Rostov-on-Don, 344011

arut.mezhunts@mail.ruhttps://orcid.org/0000-0003-3782-2860ОреховА. А.OrekhovA. A.

Орехов Алексей Анатольевич - кандидат медицинских наук, доцент кафедры хирургических болезней №3, Ростовский ГМУ; врач-хирург хирургического отделения, КБ «РЖД-Медицина» г. Ростова-на-Дону.

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Alexey A. Orekhov - Cand. Sci. (Med.), Associate Professor of the Department of Surgical Diseases No. 3, SMU; Surgeon of the Surgical Department, CHR Railway-Medicine Rostov-on-

29, Nakhichevansky Lane, Rostov-on-Don, 344022; 92a, Varfolomeev St., Rostov-on-Don, 344011

orekhov_aa@rostgmu.ruhttps://orcid.org/0000-0002-1829-3345МельниковД. А.MelnikovD. A.

Мельников Денис Андреевич - ассистент кафедры хирургических болезней №3, Ростовский ГМУ; врач-хирург хирургического отделения, КБ «РЖД-Медицина» г. Ростова-на-Дону.

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Denis A. Melnikov - Assistant of the Department of Surgical Diseases No. 3, Rostov SMU; Surgeon of the Surgical Department, CHR Railway-Medicine Rostov-on-Don

29, Nakhichevansky Lane, Rostov-on-Don, 344022; 92a, Varfolomeev St., Rostov-on-Don, 344011

d.melnikov@clcorp.ruhttps://orcid.org/0000-0002-6967-2556СаркисянА. В.SarkisyanА. V.

Саркисян Арам Ваганович - аспирант кафедры хирургических болезней №3.

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Aram V. Sarkisyan - Рostgraduate Student of the Department of Surgical Diseases No. 3.

29, Nakhichevansky Lane, Rostov-on-Don, 344022

Sarkisyan.av@bk.ruhttps://orcid.org/0000-0002-2173-2281АдизовС. А.AdizovS. A.

Адизов Сулейман Алиевич - врач-хирург хирургического отделения.

344011, Ростов-на-Дону, ул. Варфоломеева, д. 92а

Suleiman A. Adizov - Surgeon of the Surgical Department.

92a, Varfolomeev St., Rostov-on-Don, 344011

suliman_adizov@mail.ruhttps://orcid.org/0000-0002-0077-1273РогутА. А.RogutA. A.

Рогут Александр Александрович - врач-хирург хирургического отделения.

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Alexander A. Rogut - Surgeon of the Surgical Department.

92a, Varfolomeev St., Rostov-on-Don, 344011

Sanek6453@mail.ruhttps://orcid.org/0000-0003-4263-4055ЗиглерГ. Д.ZieglerG. J.

Зиглер Габриэлла Джоанна - аспирант кафедры хирургических болезней №3.

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Gabriella J. Ziegler - Рostgraduate Student of the Department of Surgical Diseases No. 3.

29, Nakhichevansky Lane, Rostov-on-Don, 344022

zieglergabriella@gmail.comhttps://orcid.org/0000-0003-3285-9496АмегнинуМ.Ж.К.AmegninouC. M.J.

Амегнину Мессан Жак Карлос - аспирант кафедры хирургических болезней №3.

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Carlos M.J. Amegninou, Рostgraduate Student of the Department of Surgical Diseases No. 3.

29, Nakhichevansky Lane, Rostov-on-Don, 344022

amemjacques@gmail.comКлиническая больница РЖД-Медицина г. Ростова-на-Дону; Ростовский государственный медицинский университетРоссияClinical Hospital Russian Railway-Medicine Rostov-on-Don; Rostov State Medical UniversityRussian FederationРостовский государственный медицинский университетРоссияRostov State Medical UniversityRussian FederationКлиническая больница РЖД-Медицина г. Ростова-на-Дону; Ростовский государственный медицинский университетРоссияRostov State Medical UniversityRussian FederationКлиническая больница РЖД-Медицина г. Ростова-на-ДонуРоссияClinical Hospital Russian Railway-Medicine Rostov-on-DonRussian Federation202220112022192142151Copyright © Хитарьян А.Г., Абовян А.А., Межунц А.В., Орехов А.А., Мельников Д.А., Саркисян А.В., Адизов С.А., Рогут А.А., Зиглер Г.Д., Амегнину М.M., 20222022Хитарьян А.Г., Абовян А.А., Межунц А.В., Орехов А.А., Мельников Д.А., Саркисян А.В., Адизов С.А., Рогут А.А., Зиглер Г.Д., Амегнину М.Khitaryan A.G., Abovyan A.A., Mezhunts A.V., Orekhov A.A., Melnikov D.A., Sarkisyan А.V., Adizov S.A., Rogut A.A., Ziegler G.J., Amegninou C.M.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.a-surgeon.ru/jour/article/view/319Введение

Введение. Несмотря на большую популярность гастроеюношунтирования по Ру и продольной резекции желудка в лечении морбидного ожирения, недостаточно изученной остается проблема развития и прогрессирования признаков саркопении у больных с сахарным диабетом 2-го типа в послеоперационном периоде.

Цель

Цель. Изучить распространенность и динамику признаков саркопении у пациентов с сахарным диабетом 2-го типа после гастроеюношунтирования по Ру и лапароскопической продольной резекции желудка в отдаленные сроки.

Материалы и методы

Материалы и методы. Наше проспективное исследование включало 257 бариатрических пациентов (170 –гастроеюношунтирование по Ру и 87 – лапароскопическая продольная резекция желудка) с сахарным диабетом 2-го типа. Всем больным проводился стандартный комплекс дооперационного исследования с дополнительным определением индекса массы скелетной мускулатуры с помощью метода биоимпедансометрии. Через 6, 12, 18 и 24 мес. проводились контрольные обследования.

Результаты

Результаты. На дооперационном этапе было выявлено 28 пациентов (16,5%) с признаками умеренной саркопении в группе гастроеюношунтирования по Ру и 15 пациентов (17,2%) в группе лапароскопической продольной резекции желудка. По данным биоимпедансометрии, через 24 мес. после операции в первой группе было выявлено 37 пациентов (25,9%) с признаками умеренной саркопении и 2 пациента (1,4%) с явлениями выраженной саркопении. Во второй группе через 24 мес. после операции статистической разницы по количеству пациентов с признаками саркопении в сравнении с дооперационным периодом не выявлено.

Выводы

Выводы. Частота развития и прогрессирования признаков саркопении после гастроеюношунтирования по Ру статистически выше, чем после лапароскопической продольной резекции желудка. В связи с этим, по нашему мнению, при выборе метода оперативного лечения морбидного ожирения с сопутствующим сахарным диабетом 2-го типа необходима детальная оценка состояния белкового обмена методом биоимпедансометрии.

Introduction

Introduction. Despite the great popularity of Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy in the treatment of morbid obesity, the problem of the development and progression of sarcopenia in patients with type 2 diabetes mellitus in the postoperative period remains insufficiently studied.

Aim

Aim. To study the prevalence and dynamics of sarcopenia in patients with type 2 diabetes mellitus after Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy in the long term.

Materials and methods

Materials and methods. Our prospective study included 257 bariatric patients (170 Roux-en-Y gastric bypass and 87 laparoscopic sleeve gastrectomy) with type 2 diabetes mellitus. All patients underwent a standard set of preoperative examination with obligatory determination of the skeletal muscle mass index using the bioelectrical impedance analysis. After 6, 12, 18 and 24 months, control examinations were carried out.

Results

Results. At the preoperative stage, 28 patients (16.5%) with signs of moderate sarcopenia were identified in the Roux-en-Y gastric bypass group and 15 patients (17.2%) in the laparoscopic sleeve gastrectomy group. According to the bioelectrical impedance analysis, 24 months after the operation, 37 patients (25.9%) with signs of moderate sarcopenia and 2 patients (1.4%) with severe sarcopenia were identified in the first group. 24 months after surgery in the second group there was no statistical difference in the number of patients with signs of sarcopenia in comparison with the preoperative period.

Conclusion

Conclusion. The frequency of development and progression of signs of sarcopenia after Roux-en-Y gastric bypass is statistically higher than after laparoscopic sleeve gastrectomy. In this regard, in our opinion, when choosing a method of surgical treatment of morbid obesity with concomitant type 2 diabetes mellitus, a detailed assessment of the state of protein metabolism by the bioelectrical impedance analysis is necessary.

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The authors declare that there are no conflicts of interest present.