不同胃转流术式治疗2型糖尿病的疗效研究

目的：比较不同胃转流术式对2型糖尿病的治疗效果。方法：30只6~8周龄雄性GK大鼠随机分成5组,每组6只。第1组：行十二指肠旷置、保持胃容量的胃空肠Roux-en-Y吻合术;第2组：行十二指肠旷置、保持胃容量的胃空肠襻式吻合术;第3组：行胃部分切除、胃空肠Roux-en-Y吻合术;第4组：行胃部分切除、胃空肠襻式吻合术。第1、3组中空肠与空肠吻合口和第2、4组中胃空肠吻合口距屈氏韧带均为3cm。第5组手术方式同第1组,但空肠与空肠吻合口距屈氏韧带10cm。观察各组大鼠手术前后口服糖耐量试验（OGTT）及空腹血糖（FBG）变化。结果：各组大鼠术后血糖均得到良好控制（P〈0.05）,第1、3组之间以及第2、4组之间差异均无统计学意义（P〉0.05）,但第1、3、5组血糖改善比第2、4组更加明显,差异有统计学意义（P〈0.05）。术后36周OGTT峰值,第1、5组较术前降低,差异有统计学意义（P〈0.05）,第2、3、4组虽较术前有所降低但差异无统计学意义（P〉0.05）。术后36周OGTT3h水平,第1、3、5组较术前明显改善（P〈0.05）,第2、4组虽较术前有所改善但差异无统计学意义（P〉0.05）。术后血糖控制和术后36周OGTT峰值及3h水平第1、5组大鼠之间均差异无统计学意义（P〉0.05）。结论：胃转流术治疗2型糖尿病是有效的,行十二指肠旷置、保持胃容量的Roux-en-Y胃空肠吻合术既能最有效降低血糖,又能使手术对机体的不利影响降低到最低限度,是相对比较理想的术式,但不宜盲目增加旷置肠襻长度。

The Study about the Effect of Different Styles of Gastric Bypass Surgery on Type 2 Diabetes

Objective：To study the treatment effects of different styles of gastric bypass surgery on type 2 diabetic GK rats.Methods： Thirty male GK rats from six-week-age to eight-week-age were randomly divided into five groups,group 1 was operated by Roux-en-Y gastrojejunostomy with duodenum exclusion and stomach capacity maintenance,group 2 was operated by loop-type gastrojejunostomy with duodenum exclusion and stomach capacity maintenance,group 3 was operated by Roux-en-Y gastrojejunostomy with partial gastrectomy,group 4 was operated by loop-type gastrojejunostomy with partial gastrectomy.The length from jejunal anastomotic stoma to the ligament of Treitz in group 1 and 3 and the length from gastrojejunal anastomotic stoma to the ligament of Treitz in group 2 and 4 was 3cm,group 5 was operated as the same way as group 1,but the length from jejunal anastomotic stoma to the ligament of Treitz was 10cm.The changes of FBG and OGTT in different groups were observed and recofede.Results： Every had good effect on controlling blood-glucose,there were no patent differences between group 1 and 3（P0.05）,as well as between group 2 and 4（P0.05）,but group 1,3 and 5 were more effective than those in group 2 and 4（P0.05）.The OGTT peak value at 36-week postoperation reduced in group 1 and 5（P0.05）,but not in group 2,3 and 4（P0.05）.The OGTT 3 h level at 36-week postoperation had obvious improvement in group 1,3 and 5（P0.05）,but not in group 2 and 4（P0.05）.There were also no patent difference in the OGTT peak value and the OGTT 3h level at 36-week postoperation between them（P0.05）.Conclusions： Gastric bypass surgery is effective to treat type 2 diabetes mellitus（T2DM）,the Roux-en-Y gastrojejunostomy with duodenum exclusion and stomach capacity maintenance is a relatively perfect operative style for not only controlling blood-glucose most effectively but also decreasing adverse effect of the body to the minimal level.Further more,we should not increase the length of intestinal loop that excluded blindly.