腹腔镜胃转流术治疗2型糖尿病合并高血压

目的比较腹腔镜胃转流术与传统方法对2型糖尿病合并高血压患者的治疗疗效。方法将41例2型糖尿病合并高血压患者随机分为手术组和对照组,以糖化血红蛋白、血压、体重指数、血脂、左室质量指数、相对室壁厚度、左室射血分数为观察指标。结果与对照组比较,手术组糖化血红蛋白、血压、体重指数、血脂、E／A、左室质量指数上均有明显改善,其差异有统计学意义（P〈0．05）,对照组与手术组在左室射血分数上比较无统计学差异（P〉0．05）。结论腹腔镜胃转流术治疗2型糖尿病合并高血压患者可明显改善糖化血红蛋白、血压、体重指数、血脂、E／A、左室质量指数。     

腹腔镜胃绕道术治疗2型糖尿病的手术护理

目前我国成人糖尿病的患病率约为9.7%,其中2型糖尿病（type 2 diabetes mellitus,T2DM）占90%[1]。腹腔镜下胃绕道手术（Roux-en-Y gastric bypass,RYGBP）可以使T2DM、高血压病等慢性疾病得到有效的控制,已成为目前手术治疗2型糖尿病的首选术式。我院于2010年1月至今完成7例腹腔镜下RYGBP手术治疗2型糖尿病,效果满意,现将手术护理配合报告如下。     

2型糖尿病行胃转流术围手术期护理

近年来发现胃转流术（Roux-en-Y）可控制2型糖尿病患者的血糖,但由于胃转流术对机体损伤大,围手术期的护理对手术的治疗效果、患者的恢复有着重要作用。2010年我科对2型糖尿病患者施行胃转流术治疗,经过围手术期的精心护理,术后效果满意,康复出院。现将围手术期的护理报告如下。     

糖尿病治疗仪治疗2型糖尿病临床疗效与安全性分析

目的：观察并分析糖尿病治疗仪治疗2型糖尿病的临床疗效和安全性。方法将我院收治的112例2型糖尿病患者进行随机分组治疗,试验组：给予糖尿病治疗仪治疗;对照组：给予传统磺脲类和双胍类降糖药。结果试验组患者的临床疗效的改善情况明显优于对照组,其总有效率高达92.8%(52/56),且试验组的不良反应率也显著低于对照组,差异显著有统计学意义(<0.05)。结论临床采用糖尿病治疗仪治疗2型糖尿病,有效地缓解患者的症状,提高治疗效果,且具有较好的安全性,应广泛推广。     

胃间质瘤的腹腔镜手术治疗及临床疗效分析

目的:探讨腹腔镜手术治疗胃间质瘤的可行性及安全性。方法:回顾分析解放军总医院肿瘤外科2010年3月~2014年9月期间经腹腔镜手术治疗的50例胃间质瘤患者的临床资料。结果:平均手术时间为(105.7±59.0)min,术中出血为(50±53.9)mL;术后进食清流食时间为(4.6±1.8)d,术后平均住院时间为(8.7±6.2)d,无手术死亡病例。肿瘤直径为1.0~16.0 cm,平均直径5.6 cm。CD34阳性者45例(90.0%),CD117阳性者42例(84.0%),S-100阳性者5例(10.0%)。中位随访23.3(1~55)个月,1例术后12个月发现肝转移,无再次手术及死亡病例。结论:对于局部可切除胃间质瘤,腹腔镜手术是一种安全、有效的治疗方式,肿瘤大小并不是手术绝对禁忌症。     

腹腔镜下治疗胃十二指肠疾病42例临床分析

目的探讨腹腔镜下手术治疗胃十二：指肠疾病的临床价值、手术方法、适应证及优缺点。方法腹腔镜手术组为胃十二指肠疾病患者42例，其中胃壁良性肿瘤切除术14例、胃十二指肠溃疡穿孔修补术11例、胃大部切除术10例、高选择性迷走神经切断术7例，应用腹腔镜技术行手术治疗。对照组为不经过腹腔镜进行同类型手术治疗的患者，每种类型手术患者10例。统计手术时间、住院时间、术中出血量和并发症。结果腹腔镜手术组肿瘤切除、穿孔修补、胃大部切除和迷走神经切断术的手术时间、术中出血量、住院时间和并发症等指标，均显著优于同类型手术的对照组。结论腹腔镜下治疗胃十二指肠疾病具有创伤小、手术时间短、术后恢复快及术后并发症少的特点。胃壁良性肿瘤切除、胃十二指肠溃疡穿孔修补、胃大部切除、高选迷走神经切断均是腹腔镜手术治疗的适应证。     

胆胰转流术改善2型糖尿病的研究进展简

 胆胰转流术（BPD）将胆胰液转流至回肠,减少胆胰液与食物的混合时间,进而减弱消化吸收。临床观察上发现,BPD可以长期稳定地改善2型糖尿病并减少糖尿病各并发症,与胃旁路术有相似的效果,其确切机制不明,目前研究提示与胃肠激素、血脂、胰岛细胞功能的改变和胆胰液转流等有关。     

2型糖尿病的胃运动功能

采用核素标记^113mIn液体试餐、^99mTc固体试餐SPECT显像技术胃半排空时间（GET1／2）和胃电图（ECG）对74例2型糖尿病（DM）进行胃运动功能研究,同时检测空腹血糖。结果（1）DM中,36例（48．6％）GET1／2延迟。60例（81．1％）EGG异常;（2）22例血糖≤7.8mmol/L,无1例固相或液相GET1／2延迟;血糖77．8mmol/L的52例中,36例（69．2％）固相GET1／2延迟,其中14例（26．9％）伴液相GET1／2延迟（P＜0．01）;（3）对照组和DM组的空腹和餐后FP、AP、FZ值均无显著差异,二组餐后AP均显著高于空腹（P＜0．05）。DM组的AR、DR和RT均较对照组显著增高或排空延迟相关。胃排空延迟与EGG异常相关。结论：血糖水平与胃排空延迟相关。血糖控制不良,胃排空与EGG异常相关。     

罗格列酮治疗2型糖尿病合并肾病的临床疗效观察

目的 观察罗格列酮治疗2型糖尿病合并肾病的临床疗效。方法 72例2型糖尿病合并肾病患者随机分为对照组和治疗组，对照组给予胰岛素和二甲双胍治疗，治疗组在对照组基础上合用罗格列酮，共16周。观察两组治疗前后空腹血糖（FBG）、餐后2h血糖（2hBG）、空腹胰岛素（FINS）、糖化血红蛋白（HbAlc）、甘油三脂（1c）、低密度脂蛋白（LDL-C）、高密度脂蛋白（HDL-C）、纤维蛋白原（Fib）定量及24h尿自蛋白排泄率（UAER）以及肾功能改变，计算胰岛素敏感指数（ISI），分析比较各指标。结果治疗组较对照组治疗后FBG、HbAlc、LDL-C、FINS、TG、Fib水平明显降低（P〈0．05），并显著降低2hBG和uAER（P〈0．01），同时提高HDL-C水平和ISI（P〈0．05）。结论 罗格列酮治疗2型糖尿病合并肾病疗效显著。。     

泽马可治疗2型糖尿病性胃轻瘫的疗效观察

糖尿病性胃轻瘫是糖尿病性胃肠神经病变的常见表现，我们用泽马可（马来酸替加色罗）治疗2型糖尿病性胃轻瘫，取得了较好的疗效，报道如下。     

Roux-en-Y gastric bypass for Chinese type 2 diabetes mellitus patients with a BMI,28kg/m~2:a multi-institutional study

Roux-en-Y gastric bypass surgery(RYGB) has been demonstrated to be successful for treating type-II diabetes2mellitus(T2DM) patients with a body mass index(BMI),30 kg/m,but reports of RYGB for T2 DM patients with22 a BMI,28 kg/mare lacking.T2 DM patients with a BMI,28 kg/mwere prospectively recruited to participate in this study in four hospitals.The endpoint was T2 DM remission(defined by fasting blood glucose(FBG) level,110 mg/d L and hemoglobin(Hb)A1c level,6.0% at 12 months postoperatively).Predictors of remission were investigated by univariate and multivariate analyses.Eighty-six patients were assessed.Eighty-five patients underwent RYGB,with one conversion to open surgery.We compared the values of various variables before and after2 surgery.The mean BMI decreased from 24.68±2.12 to 21.72±2.43 kg/m(P,0.001).Fifty-eight(67.4%) patients were not treated by drugs or insulin after surgery,and 20 patients(23.3%) had complete remission of T2 DM at12 months after surgery with an acceptable number of complications.The mean Hb A1 c level in the remission group was significantly lower than that in the non-remission group.Patients with a higher weight,lower Hb A1 c level,higher C-peptide level,and higher FBG level were more likely to have T2 DM remission in multivariate2 analyses.In conclusion,RYGB was effective and safe for treating T2 DM patients with a BMI,28 kg/m.Complete remission can be predicted by cases having a higher weight,lower Hb A1 c level,higher C-peptide level,and higher FBG level.     

Bariatric surgery in old age:a comparative study of laparoscopic Roux-en-Y gastric bypass and sleeve gastrectomy in an Asia centre of excellence

Bariatric surgery has been proved to be the safest and efficient procedure in treating morbid obese patients,but data is still lacking in the elderly population.The aim of our study was to compare the safety and efficacy of laparoscopic Roux-en-Y gastric bypass(LRYGB) and sleeve gastrectomy(LSG) in patients aged more than 55 years.We performed2 a retrospective review of a prospectively collected database.All patients with body mass index(BMI) §32 kg/mand aged more than 55 years undergoing LRYGB or LSG in BMI Surgery Centre,E-Da Hospital between January 2008 and December 2011 with at least one year of follow up were included for the analysis.Demography,peri-operative data,weight loss and surgical complications were all recorded and analyzed.Mean age and BMI of these 68 patients22(22 males and 46 female) were 58.8 years(55-79 years) and 39.5 kg/m(32.00-60.40 kg/m).LRYGB was performed in 44 patients and LSG in 24 patients.The two groups were comparable in their preoperative BMI,American Society of Anaesthesia(ASA) score and gender distribution.LSG patients were significantly older than patients receiving LRYGB.The proportion of type 2 diabetes preoperatively was significantly higher in LRYGB patients as compared to LSG patients(88.63% vs.50%; P,0.01).The prevalence of other co-morbidities was similar and comparable2 between the groups.Mean BMI in the LRYGB and LSG groups at the end of 1 year were 28.8 kg/mand228.2 kg/m,respectively,and there was no statistically significant difference in mean percentage of excess weight loss(%EWL) at 1 year.The percentage of resolution of diabetes was significantly higher in LRYGB(69.2%) as compared to LSG(33.3%).On the other hand,there was no statistical difference in the percentage of resolution of hypertension,hyperlipidemia and fatty liver hepatitis.The overall morbidity and re-operation rate was higher in LRYGB patients.In morbidly elderly patients,both surgeries achieved good weight loss and resolution of comorbidities.LRYGB is superior to LSG in terms of diabetes remission but carries higher complication rates even at high volume centres.     

Roux-en-Y胃旁路术对肥胖大鼠肾脏糖异生的影响

目的研究胃旁路术后肥胖大鼠糖代谢及肾脏糖异生的改变。方法将大鼠分为:对照组、肥胖模型组(高脂饮食诱导)、假手术组和手术组(胃旁路术干预模型组)。术后检测血脂、血糖和胰岛素并计算胰岛素抵抗指数(HOMA-IR),行葡萄糖耐量实验并计算曲线下面积(AUG);q-PCR检测肾脏葡萄糖6磷酸酶(G6P)和磷酸烯醇式丙酮酸羧激酶(PEPCK)mRNA表达,Western blot检测G6P、PEPCK、p-IRS1和p-Akt蛋白表达。结果相较肥胖模型组和假手术组,手术组大鼠体质量、血糖、血脂、胰岛素、HOMA-IR和AUG均明显降低(P0.05);G6P和PEPCK mRNA表达及蛋白含量明显降低(P0.05);p-IRS1和p-Akt蛋白含量明显升高(P0.05)。结论胃旁路术能够显著改善肥胖大鼠糖代谢和胰岛素抵抗,其机制可能与肾脏糖异生关键酶表达降低,肾脏糖异生及糖输出减弱有关。     

Metabolic bariatric surgery and type 2 diabetes mellitus: an endocrinologist's perspective

Traditional treatment of T2DM consisting of modification of diet, an exercise regimen, and pharmacotherapy has problems of poor lifestyle modifications and fail tend of treatment over time, now bariatric surgery is recommended for treatment of obese patients with T2DM because its great improvements on weight loss and metabolic. In this article, effects of bariatric surgery on diabetes and diabetes-related complications are reviewed.     

Secondary male factor infertility after Roux-en-Y gastric bypass for morbid obesity: case report

Surgical treatments such as the Roux-en-Y gastric bypass operation result in the successful treatment of morbid obesity; however, this type of operation may cause long-term side effects due to the reduced absorption of nutrients. Here, we present data suggesting that this operation can result in secondary infertility in males. Six healthy, previously fertile male subjects presented in our centre for secondary infertility after a Roux-en-Y gastric bypass operation for morbid obesity. Reproductive function was assessed with a series of spermiograms, and by testicular biopsy. Secondary azoospermy with complete spermatogenic arrest was diagnosed. The results suggest that weight reduction surgery may cause reproductive dysfunction.     

Crystallization of oral fluid components in patients with type 2 diabetes mellitus

Crystal aggregations of oral fluid from normal subjects and patients with type 2 diabetes mellitus were examined. Morphological signs characterizing crystal aggregations of salivary pools from patients with type 2 diabetes mellitus are described and classified.Translated from Byulleten Eksperimentalnoi Biologii i Meditsiny, Vol. 138, No. 9, pp. 345–347, September, 2004     

Crystallization of oral fluid components in patients with type 2 diabetes mellitus

Crystal aggregations of oral fluid from normal subjects and patients with type 2 diabetes mellitus were examined. Morphological signs characterizing crystal aggregations of salivary pools from patients with type 2 diabetes mellitus are described and classified. Translated fromByulleten’ Eksperimental’noi Biologii i Meditsiny, Vol. 138, No. 9, pp. 345–347, September, 2004     

Defining the genetic contribution of type 2 diabetes mellitus

Type 2 diabetes mellitus is a common multifactorial genetic syndrome, which is determined by several different genes and environmental factors. It now affects 150 million people world wide but its incidence is increasing rapidly because of secondary factors, such as obesity, hypertension, and lack of physical activity. Many studies have been carried out to determine the genetic factors involved in type 2 diabetes mellitus. In this review we look at the different strategies used and discuss the genome wide scans performed so far in more detail. New technologies, such as microarrays, and the discovery of SNPs will lead to a greater understanding of the pathogenesis of type 2 diabetes mellitus and to better diagnostics, treatment, and eventually prevention.     

2型糖尿病合并甲状腺功能减退的影响因素分析研究

目的：探究2型糖尿病(type 2 diabetes mellitus,T2DM)合并甲状腺功能减退的影响因素。方法：选择2013年1月至2015年6月在我院接受治疗的2型糖尿病患者784例。将2型糖尿病合并甲状腺功能减退的71例患者作为甲减组,甲状腺功能正常的713例患者作为T2DM组。比较甲减组和T2DM组患者的临床资料,用单因素分析和Logistic回归分析其影响因素。结果：2型糖尿病合并甲状腺功能减退的发病率为9.06%,其中临床甲减16例,为2.04%,亚临床甲减55例,为7.02%。比较甲减组与T2DM组患者的一般临床资料,发现2型糖尿病合并甲状腺功能减退与年龄、糖尿病病程、ABI、FCP、E/A、TC、TG、LDL-C、Lp(a)、S-CRP、UAER、TPO-Ab、性别、吸烟、冠心病、DN、DNP、DR、DF、PAD、DM治疗方式有关(P<0.05)。将2型糖尿病患者是否合并甲状腺功能减退作为因变量,将上述因素纳入Logistic多元回归分析,结果显示年龄、吸烟、胰岛素治疗、TPO-Ab是2型糖尿病患者合并甲状腺功能减退的独立危险因素。结论：年龄、吸烟、胰岛素治疗、TPO-Ab是2型糖尿病患者合并甲状腺功能减退的独立危险因素,2型糖尿病患者应定期进行甲状腺功能检查,以便及早诊断和干预甲状腺功能减退。