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不同胃转流术式治疗2 型糖尿病的疗效研究.pdf

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不同胃转流术式治疗2 型糖尿病的疗效研究.pdf

ChineseJournalofClinicalMedicine,2010.Vol.17,No.3nullnullnullÏS5DÐnull2010M6null»17null»3ùnullnullnull‚÷nullnull‚ÇŒTÍ2˜Uh¥rùî黄文海1null张学利2null章勇1null陈宗祐31.复旦大学附属金山医院普外科,上海null2005402.南方医科大学附属奉贤医院普外科,上海null2014003.复旦大学附属华山医院普外科,上海null200040K1null目的比较不同胃转流术式对2型糖尿病的治疗效果b方法30只68周龄雄性GK大鼠随机分成5组,每组6只b第1组行十二指肠旷置a保持胃容量的胃空肠RouxnullennullY吻合术第2组行十二指肠旷置a保持胃容量的胃空肠襻式吻合术第3组行胃部分切除a胃空肠RouxnullennullY吻合术第4组行胃部分切除a胃空肠襻式吻合术b第1a3组中空肠与空肠吻合口和第2a4组中胃空肠吻合口距屈氏韧带均为3cmb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10cmb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b结果各组大鼠术后血糖均得到良好控制P0.05,但第1a3a5组血糖改善比第2a4组更加明显,差异有统计学意义P0.05b术后36周OGTT3h水平,第1a3a5组较术前明显改善P0.05b术后血糖控制和术后36周OGTT峰值及3h水平第1a5组大鼠之间均差异无统计学意义P0.05b结论胃转流术治疗2型糖尿病是有效的,行十二指肠旷置a保持胃容量的RouxnullennullY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b1oMnull胃转流术null手术方式null2型糖尿病null效果ÏmsË|nullR656.61nullnullÓDSM’nullAÁ¯ŠvÐMSÐùîÁI|EYF160001YßT€nullfÐæ,Enullmaillejing1996yahoo.cnTheStudyabouttheEffectofDifferentStylesofGastricBypassSurgeryonType2DiabetesnullHUANGWennullhai1nullZHANGXueli2nullZHANGYong1nullCHENZongyou3null1.DepartmentofGeneralSurgery,JinsnullhanHospital,FudanUniversity,Shanghai,200540,China2.DepartmentofGeneralSurgery,FengxnullianHospital,SouthernMedicalUniversity,Shanghainull201400,China3.DepartmentofGeneralSurnullgery,HuashanHospital,FudanUniversity,Shanghainull200040,ChinaAbstractnullObjectiveTostudythetreatmenteffectsofdifferentstylesofgastricbypasssurgeryontype2diabeticGKrats.MethodsThirtymaleGKratsfromsixnullweeknullagetoeightnullweeknullagewererandomlydividedintofivegroups,group1wasoperanulltedbyRouxnullennullYgastrojejunostomywithduodenumexclusionandstomachcapacitymaintenance,group2wasoperatedbyloopnulltypegastrojejunostomywithduodenumexclusionandstomachcapacitymaintenance,group3wasoperatedbyRouxnullennullYgastrojejunostomywithpartialgastrectomy,group4wasoperatedbyloopnulltypegastrojejunostomywithpartialgastrectomy.ThelengthfromjejunalanastomoticstomatotheligamentofTreitzingroup1and3andthelengthfromgastrojejunalanastonullmoticstomatotheligamentofTreitzingroup2and4was3cm,group5wasoperatedasthesamewayasgroup1,butthelengthfromjejunalanastomoticstomatotheligamentofTreitzwas10cm.ThechangesofFBGandOGTTindifferentgroupswereobservedandrecofede.ResultsEveryhadgoodeffectoncontrollingbloodnullglucose,therewerenopatentdifferencesbenulltweengroup1and3P0.05,aswellasbetweengroup2and4P0.05,butgroup1,3and5weremoreeffectivethanthoseingroup2and4P0.05.TheOGTT3hlevelat36nullweekpostoperationhadobviousimprovementingroup1,3and5P0.05.TherewerealsonopatentdifferenceintheOGTTpeakvalueandtheOGTT3hlevelat36nullweekpostoperationbetweenthemP0.05.ConclusionsGastricbypasssurgeryiseffectivetotreattype2diabenulltesmellitusT2DM,theRouxnullennullYgastrojejunostomywithduodenumexclusionandstomachcapacitymaintenanceisarelanulltivelyperfectoperativestylefornotonlycontrollingbloodnullglucosemosteffectivelybutalsodecreasingadverseeffectofthebodytotheminimallevel.Furthermore,weshouldnotincreasethelengthofintestinalloopthatexcludedblindly.KeyWordsnullGastricbypasssurgerynullOperativestylesnullType2diabetesnullEffectnullnullUhBÕÈnhah,Ï2˜Uh9095,ÀÂíôÍŸ¥ÍZEbRunull442nullÏS5DÐnull2010M6null»17null»3ùnullnullChineseJournalofClinicalMedicine,2010.Vol.17,No.3bino1CÇŒô2˜Uh¥g—¡Ñ€ûò¹eÅ8É“,εr¹†®Óa¿ÿ0bPatriti©2ùîC,ÇŒüA¿ÿdg—ŸUhvŠ¥Ó£Üb7ÇŒgiÕ‚¥mŒZT,îèBÕmŒZT¥rKD‚bbùî2˜Uhîþ˜GKvŠGotonullKakizakiratsT¹L,1‚mŒZT¥rb1nullÐZE1.1null实验动物和分组null68Û¦ŸGKvŠ®ÏSýZLîþϏZ®žXLîþµK³430º,Ûsî5F,ÄF6º,mŒZTsY¹»1F›E˂ÂaûǸ¥ÇbËRouxnullennullYÖ†Œ»2F›E˂ÂaûǸ¥ÇbËÅTÖ†Œ»3F›Ç†sMaÇbËRouxnullennullYÖ†Œ»4F›Ç†sMaÇbËÅTÖ†Œ»1a3FÏbËÐbËÖ†g„»2a4FÏÇbËÖ†gyf¨{¹3cmb»5F›E˂ÂaûǸ¥ÇbËRouxnullennullYÖ†Œ,ŒbËÐbËÖ†gyf¨{¹10cmb1.2null实验方法nullvŠa‹Ìâª,MéÁ†|Ó©b´ÓFBGag›0kOGTTbŒïÌJ,oÂ75mgnullkg1„5mgnullkg1´8ÿJbŒª4³36ÛbŒª1Ûa2Ûa4Ûa36ÛsYMéÁ†|Ó©FBGaOGTTb©çFBGvŠïÌJ1214hbsY10a30a60a120„180minH©çÓ,|ÓZEbÓ©çP¨3³¥„F˜ÓNSureStepPlus,Lifescan,JohnsonJohnsonb1.3null统计学处理null²T”nullSµŸVUbòFW©´1¨t_Zµsϔ‚˜†žÿŸZµŸ5¨Ç„_b¨Stata7.0ÈqbP0.05¹µsµd9Ðilb2null²nullnullT2.1null各组术后血糖的变化nullnV1bV1nullòFͪFBGmmolnullL1MÄ1FYŒŒª4یª36Û»1F16.1null6.47.2null2.5null7.2null1.8null»2F14.0null3.09.6null2.09.8null1.1»3F14.0null3.57.8null2.26.8null0.8»4F13.7null2.59.1null2.39.3null1.2»5F14.5null1.57.2null0.96.6null0.9nullnullÿЌM1,P0.05»2F1,nullP0.052.2null各组术后OGTT变化nullnV2ÐV3bV2nullòFͪOGTT‚´mmolnullL1MÄ1nullxnullsFYŒŒª36Û»1F31.9null1.525.5null3.1»2F30.5null2.027.5null3.5»3F30.5null3.325.7null7.2»4F30.0null2.027.6null4.4»5F30.9null2.026.1null4.2nullnullÿЌM1,P0.05V3nullòFͪOGTT3h£ÜmmolnullL1MÄ1nullxnullsFYŒŒª36Û»1F23.6null6.315.5null1.7»2F24.4null5.418.4null2.9»3F22.2null2.816.0null2.1»4F23.1null3.817.9null3.5»5F21.2null7.115.0null2.2nullnullÿЌM1,P0.053nullnullnull‚Uhø²¦ËrB¥¤Ÿh­B,hy„hÅÀÂÛ†ü,¥ÍZE³Ô»ûÍ,ÙsBÕôÍŸ¥ÍZE¦ÌB°mï¥SbRubino©1Vg—¡mŒ¥ÍrTÏi“¹4³žmŒµr¹eÅ8É“,ÎPÑ€îô¥2˜Uh¤žµr¥eÅbÙ¥hgmŒÏ,ÇŒùîO,ôg—¡¥2˜UhÑ€ÍrTKzb†VÍrTŸA,Rubino3ª¹,ÇËRouxnullennullYsŒRYGB,RouxnullennullYgastricbynullpass„‰OsŒBPD,biliopancreaticdivernullsion2˜Uh¥ÍrT1g—¡¥ÍrT÷z,y7ë¹nullUhmŒnull»¬÷†ab5dg—¥2˜UhÑ€îþLÏ,9û|¤eÅÓ¥rT4bfS©5ùî9VüGKvŠL†Ç¥mŒª,JÀµh,8É9F¥Hb´Ó0üA¿ÿbyN,AŸÇŒÍ2˜Uhµr¥b”Ѐ4,6null7ª¹mŒÍ2˜Uh¥ØmŒ¥°¤ÍrT,7‚JþÆh8Éhb1ª¥ËO›àÅb¾àÂèT¨ö1µÕLªnullËLªnull443ChineseJournalofClinicalMedicine,2010.Vol.17,No.3nullnullnullÏS5DÐnull2010M6null»17null»3ùnullforeguthypothesis„nullªËLªnullhindguthynullpothesisbËLªþÉE7ÍlË¥O,htÅO›Í†î„sߥÍ,V7\PO›Í¥†î„db,.À9FO›Í¥ùËŸ8bRubino©9C,†BÇbËÖ†9F®åY,ŒiÆbÍlË,Óí¿ÿQmŒ,PÍlËb´,0A÷¿ÿ,yNw©,EËb˕ŒªÍlË¥‚Â2˜Uh046¥1oyÍbùîÏ,5Õ‚¥mŒZT‚ÂEË„ÍbË,²T9AUÓµA÷¥eÅT¨,Œª0µ‚ñ¥¿ÿbùî²TAU,ÇbËRouxnullennullYÖ†Ó¥eÅ1ª¿ÇbËÅTÖ†,0¥¿ÿ9A÷,Vª€¯µ†ǸþRÆÍlË,•YmŒrT,ƒ9Q£‚Â¥ÍlËÓeÅÏ¥1T¨bM7ýBÕmŒZTJþRÆÍlË¥Àq†®,7O‰OA÷y¥žríË,µæ¿Ó¥eÅ,ƒ˜†Flatt©10¥nullªËLªnull4Ä,JþíË¥O\ÉË÷ŸsßÍ¥†î„sß,V79FO›Í¥†î„db,¿ÿ“ÛF®O›Í¥ùËŸbyN,EË„ÍbË“,Ó¥eÅÏíË»¬9è1¥T¨b6“,ùî²TÎC,¸FdžsMi‚ÉB„¿ÿÓ¥eÅ,Q7Vö9FmŒ¥7„p¸,y74UÇmŒÍ2˜Uh¥VñÏT¨‚vbƒÐRubino©34¥2˜UhVüBñlË“Sh¥LªMÖ†bٖ2˜UhVBñlË“Sh,ŒùîC9F‚ÂËÅ¥ÉÓ¥eÅ0¥¿ÿíüAT¨,OÁŒªËüE„p¸¥3,8Å΂bb9­,E˂ÂaûǸ¥ÇbËRouxnullennullYÖ†ŒKµr†®Ó,»‚Á8Á3üA¥‚æ•Y,M1ØX¥ŒT,O‚R©9F‚ÂËÅ¥ÉbeÅÓ¥ÅVÕyÍ8†T¨¥²T,ùùrTÑ€ùùhØ3Ø¥•Y³ÉB„ùîb•IÓD1nullRubinoF.BariatricsurgeryeffectsonglucosehomeostasisJ.LippincottWilliamsWilkins,2006,94497null507.2nullPatritiA,FacchianoE,DoniniA.Effectofduodenalnulljejunalexclusioninanonobeseanimalmodeloftype2diabetesanewperspectiveforanolddiseaseJ.AnnSurg,2004,2402388null389.3nullRubinoF.Istype2diabetesanoperableintestinaldiseaseAprovocativeyetreasonablehypothesisJ.DiabetesCare,2008,31Suppl2290null296.4nullc§,ç7祐,朱江帆,等.胃转流术治疗2型糖尿病的实验研究J.ÏS5DÐ,2006,136960null962.5nullfS,Ð,£,©.ǕmŒÍII˜Uh¥8öJ.Ï¿ôY“S½,2005,209599.6nullfÐæ,ç7祐,黄文海,等.胃旁路术对2型糖尿病的临床治T¨J.ÏS5DÐ,2009,163480null482.7nullPoriesWJ,AlbrechtRJ.EtiologyoftypenulldiabetesmellitusroleoftheforegutJ.WoldJSurg,2001,254527null531.8nullSugermanHJ,WolfeLG,SicaDA,etal.DiabetesandhypernulltensioninsevereobesityandefectsofgastricbypassnullinducedweightlossJ.AnnSurg,2003,2376751null756.9nullRubinoF,ForgioneA,CummingsDE,etal.Themechanullnismofdiabetescontrolaftergastrointestinalbypasssurgeryrenullvealsaroleoftheproximalsmallintestineinthepathophysiolnullogyoftype2diabetesJ.AnnSurg,2006,2445741null749.10nullFlattPR.EffectivesurgicaltreatmentofobesitymaybemedianulltedbyablationoftheliponullgenicguthormonegastricinhibitorypolypeptideGIPevidenceandclininullcalopportunityfordevelnullopmentofnewobesitynulldiabetesdrugsJDiabVascDisRes,2007,42151null153.444

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