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A Prospective Randomized Controlled Study of Gastric Bypass Surgery for Nonobese Type 2 Diabetes Mellitus

Author: WeiZuoMing
Tutor: ZhengChengZhu
School: Second Military Medical University
Course: Surgery
Keywords: Gastrectomy Gastric bypass surgery Type 2 diabetes mellitus Random Clinical Research
CLC: R587.1
Type: Master's thesis
Year: 2010
Downloads: 155
Quote: 0
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Abstract

Background gastrointestinal surgery role in the treatment of type 2 diabetes (T2DM) is found in the analysis accept morbidly obese patients for bariatric surgery. Existing reports suggest that GBP and BPD surgery are satisfied with the long-term efficacy of the treatment of type 2 diabetes with obesity, the majority of patients with T2DM achieve a full recovery. Recent reports suggest that body mass index less than 35kg/m2 patients, RYGB surgery on T2DM have a similar effect, even higher remission rate. Similar results in animal experiments RYGB surgery in obese and non-obese rats T2DM model significantly improved. The study also showed that the antidiabetic effects of RYGB may be related to the small intestine bypass. But still need more clinical studies to be confirmed. Surgical treatment for research purposes by comparing the stomach digestive tract reconstruction after resection of four common surgical evaluation of small pieces of the proximal small intestine (duodenum) in the digestive tract reconstructive surgery is excluded from the nutrient absorption process of T2DM speculated hypoglycemic effects of gastric bypass and key parts, the results are expected to guide such patients to choose the way of the digestive tract reconstruction, and to explore the mechanism of action of the anti-diabetic gastric bypass surgery. Research methods prospective randomized controlled study was to gastric bypass surgery for non-obesity (BMI <35kg/m2) T2DM anti-diabetic effects. Unless the patient is unable to adopt some kind of surgery, 40 patients with T2DM accept other surgical diseases gastrectomy patients were randomly divided into four groups, the Y-shaped anastomosis surgery (RY) were treated with total gastrectomy gastrectomy Bi II gastric jejunostomy surgery (B Ⅱ) and distal gastrectomy Billroth Ⅰ gastroduodenal anastomosis (B I), proximal gastrectomy the esophageal gastric remnant anastomosis (PG) 4 different surgical. Patients were followed up for 6 months, mainly to improve the situation of the comparison of these four kinds of surgical diabetes. Dose frequency of clinical evaluation and observation indicators including surgery before and after the body mass index (BMI), waist circumference, taking hypoglycemic agents, fasting blood glucose, glycosylated hemoglobin, serum insulin and C-peptide levels. 4 different surgical results are basically the same clinical effect of surgical treatment of diseases, the patient's hospital stay, surgery healing, body weight and waist circumference change and disease recovery state, etc. there is no significant difference (P gt; 0.05). I group B 3 control blood sugar normal reduction of oral hypoglycemic agents, seven were unchanged; PG group 2 control blood sugar normal insulin reduction, eight were unchanged. RY group discontinued normal blood glucose and glycosylated hemoglobin levels, reduce the 7 control blood sugar normal amount of insulin, and one did not change; withdrawal B II group, blood glucose and glycosylated hemoglobin levels were normal, 2 control blood sugar normal insulin reduction, oral hypoglycemic drug reduction, no change. B II group and RY postoperative fasting blood glucose decreased, B Ⅰ group and PG group postoperative blood glucose no significant improvement in change (P gt; 0.05). The comparison between groups showed that postoperative B group II and RY groups blood sugar drops significantly stronger than B Ⅰ group and PG group (P lt; 0.05), and changes in blood sugar among other groups, no significant differences (P gt; 0.05). II patients in group B after a month, RY group after 2 months of glycated hemoglobin significantly lower (P lt; 0.05), glycosylated hemoglobin after B Ⅰ group and PG group had no significant change (P gt; 0.05). Postoperative B Ⅱ group (2 months: P lt; 0.05; 6 months: P lt; 0.01)) and RY group (6 months: P lt; 0.01) lower glycosylated hemoglobin B Ⅰ group and PG group comparison there are significant differences ; the remaining differences between the groups was not significant (P gt; 0.05). B II group and the the RY group after a plasma insulin levels were significantly elevated (P lt; 0.05), and no significant change (P gt B Ⅰ group and PG group before and after surgery, insulin; 0.05). Comparison between groups B II group and RY group the postoperative plasma insulin levels and B Ⅰ group and PG group was significantly different (P lt; 0.05); between other groups had no significant difference (P gt; 0.05). B II group and RY group were C-peptide levels were progressively increased to six months increased most significantly (P lt; 0.01), C-peptide level B Ⅰ group and PG group of patients before and after surgery was no significant difference (P gt ; 0.05). Postoperative B Ⅱ group and RY group C-peptide levels and B Ⅰ group and PG group significant differences P lt; 0.05), the remaining difference between the groups was not statistically significant significance (P gt; 0.05). 4 kinds of surgical research conclusions in this article on the therapeutic effect of the original disease, no significant differences, but the the RY surgical and B II procedure on the T2DM have significant effects, B Ⅰ surgical and PG technique less effective. The results showed that gastric bypass surgery than non-obese T2DM non-bypass group effect is significant. Gastrectomy did not have a key role in the surgical treatment of diabetes had no significant effect, because of the four kinds of surgical total gastrectomy or partial gastrectomy of the different parts of the fight against diabetes; hypoglycemic effect is related mainly with the bypass reconstruction Bypass exclude the duodenum and the upper jejunum may be the key to the anti-diabetic action. Further, RY and B II 2 gastric bypass formula different, but almost no difference in the effect of the anti-diabetic, which shows the upper small intestine in the length range of the present study, different lengths and different ways bypass does not significantly affect the stomach The bypass surgery antidiabetic therapeutic effect. Based on the above results and the existing literature, we infer the excluded gastric bypass surgery in the upper part of the small intestine, the duodenum may be most closely related to the site of anti-diabetic effects. Our results demonstrate that the non-obese T2DM postoperative drop the glycemic effect independent of changes in body mass, Department of gastric bypass anti-diabetes may improve islet function, increased secretion of insulin and C-peptide levels, lower glycosylated hemoglobin, improve glucose metabolism in the environment results intestine - islet axis doctrine consistent. Surgery associated with the T2DM gastrointestinal surgical diseases, should be used whenever possible similar RYGB bypass surgical reconstruction, so that patients get the best treatment effect.

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