2胆胰分流术与胃旁路术治疗2型糖尿病的机制比较

临床研究发现,减重手术可以改善甚至治愈糖尿病。采用不同术式其效果不一,其中胆胰分流术（BPD）对糖尿病治愈率最高,达98％以上：其次为Roux-en-Y胃旁路术（RGBP）,可达80％。但这两种手术对于治疗糖尿病的具体作用机制尚不明确．且争议较多。BPD与RGBP术后患者体内多种激素水平、尤其是肠道激素GLP．1和GIP的变化并不一致．很难用前肠及后肠假说完全解释。本综述根据国内外最新研究结果．比较了BPD及RGBP两种术式的解剖结构及术后GLP．1和GIP的变化,并对两种术式在治疗糖尿病上可能存在的不同机制进行了探讨。

Comparison of different mechanisms in the treatment of type 2 diabetes between biliopancretic diversion and Roux-en-Y gastric bypass

A large number of clinical studies indicate that bariatric surgery leads to improvement or resolution of type 2 diabetes. The outcomes vary depending on procedure adopted. Biliopancreatic diversion(BPD) is associated with the highest cure rate(98%), followed by Roux-en-Y gastric bypass(RGBP)(80%). However, the mechanism is still unclear and controversial. The changes of many hormones after surgery are different between BPD and RGBP, especially some gastrointestinal hormones such as GLP-1 and GIP,however it cannot be fully explained by the widely known hindgut hypothesis and the foregut hypothesis. This review is intended to compare the anatomical structures and postoperative gastrointestinal hormones GLP-1 and GIP changes between the two procedures according to the latest researches in the world, and discussed different mechanisms which may take effect in improving diabetes.