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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,2010VOL17,NO3NULLNULLNULLS5DNULL2010M6NULL17NULL3NULLNULLNULL‚NULLNULL‚ŒT2˜UHR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NULL200540;2南方医科大学附属奉贤医院普外科,上海NULL201400;3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P005,第1A3组之间以及第2A4组之间差异均无统计学意义P005,但第1A3A5组血糖改善比第2A4组更加明显,差异有统计学意义P005B术后36周OGTT峰值,第1A5组较术前降低,差异有统计学意义P005,第2A3A4组虽较术前有所降低但差异无统计学意义P005B术后36周OGTT3H水平,第1A3A5组较术前明显改善P005,第2A4组虽较术前有所改善但差异无统计学意义P005B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P005B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MS|NULLR65661NULLNULLDSM’NULLAŠVMSI|EYF160001YT€NULLF,ENULLMAILLEJING1996YAHOOCNTHESTUDYABOUTTHEEFFECTOFDIFFERENTSTYLESOFGASTRICBYPASSSURGERYONTYPE2DIABETESNULLHUANGWENNULLHAI1NULLZHANGXUELI2NULLZHANGYONG1NULLCHENZONGYOU3NULL1DEPARTMENTOFGENERALSURGERY,JINSNULLHANHOSPITAL,FUDANUNIVERSITY,SHANGHAI,200540,CHINA;2DEPARTMENTOFGENERALSURGERY,FENGXNULLIANHOSPITAL,SOUTHERNMEDICALUNIVERSITY,SHANGHAINULL201400,CHINA;3DEPARTMENTOFGENERALSURNULLGERY,HUASHANHOSPITAL,FUDANUNIVERSITY,SHANGHAINULL200040,CHINAABSTRACTNULLOBJECTIVETOSTUDYTHETREATMENTEFFECTSOFDIFFERENTSTYLESOFGASTRICBYPASSSURGERYONTYPE2DIABETICGKRATSMETHODSTHIRTYMALEGKRATSFROMSIXNULLWEEKNULLAGETOEIGHTNULLWEEKNULLAGEWERERANDOMLYDIVIDEDINTOFIVEGROUPS,GROUP1WASOPERANULLTEDBYROUXNULLENNULLYGASTROJEJUNOSTOMYWITHDUODENUMEXCLUSIONANDSTOMACHCAPACITYMAINTENANCE,GROUP2WASOPERATEDBYLOOPNULLTYPEGASTROJEJUNOSTOMYWITHDUODENUMEXCLUSIONANDSTOMACHCAPACITYMAINTENANCE,GROUP3WASOPERATEDBYROUXNULLENNULLYGASTROJEJUNOSTOMYWITHPARTIALGASTRECTOMY,GROUP4WASOPERATEDBYLOOPNULLTYPEGASTROJEJUNOSTOMYWITHPARTIALGASTRECTOMYTHELENGTHFROMJEJUNALANASTOMOTICSTOMATOTHELIGAMENTOFTREITZINGROUP1AND3ANDTHELENGTHFROMGASTROJEJUNALANASTONULLMOTICSTOMATOTHELIGAMENTOFTREITZINGROUP2AND4WAS3CM,GROUP5WASOPERATEDASTHESAMEWAYASGROUP1,BUTTHELENGTHFROMJEJUNALANASTOMOTICSTOMATOTHELIGAMENTOFTREITZWAS10CMTHECHANGESOFFBGANDOGTTINDIFFERENTGROUPSWEREOBSERVEDANDRECOFEDERESULTSEVERYHADGOODEFFECTONCONTROLLINGBLOODNULLGLUCOSE,THEREWERENOPATENTDIFFERENCESBENULLTWEENGROUP1AND3P005,ASWELLASBETWEENGROUP2AND4P005,BUTGROUP1,3AND5WEREMOREEFFECTIVETHANTHOSEINGROUP2AND4P005THEOGTTPEAKVALUEAT36NULLWEEKPOSTOPERATIONREDUCEDINGROUP1AND5P005,BUTNOTINGROUP2,3AND4P005THEOGTT3HLEVELAT36NULLWEEKPOSTOPERATIONHADOBVIOUSIMPROVEMENTINGROUP1,3AND5P005,BUTNOTINGROUP2AND4P005THEREWEREALSONOPATENTDIFFERENCEINTHEOGTTPEAKVALUEANDTHEOGTT3HLEVELAT36NULLWEEKPOSTOPERATIONBETWEENTHEMP005CONCLUSIONSGASTRICBYPASSSURGERYISEFFECTIVETOTREATTYPE2DIABENULLTESMELLITUST2DM,THEROUXNULLENNULLYGASTROJEJUNOSTOMYWITHDUODENUMEXCLUSIONANDSTOMACHCAPACITYMAINTENANCEISARELANULLTIVELYPERFECTOPERATIVESTYLEFORNOTONLYCONTROLLINGBLOODNULLGLUCOSEMOSTEFFECTIVELYBUTALSODECREASINGADVERSEEFFECTOFTHEBODYTOTHEMINIMALLEVELFURTHERMORE,WESHOULDNOTINCREASETHELENGTHOFINTESTINALLOOPTHATEXCLUDEDBLINDLYKEYWORDSNULLGASTRICBYPASSSURGERY;NULLOPERATIVESTYLES;NULLTYPE2DIABETES;NULLEFFECTNULLNULLUHBNHAH,2˜UH9095,ŸZEBRUNULL442NULLS5DNULL2010M6NULL17NULL3NULLNULLCHINESEJOURNALOFCLINICALMEDICINE,2010VOL17,NO3BINO1CŒ2˜UHG—€E8“,R†A0BPATRITI2C,ŒADG—ŸUHVŠB7ŒGI‚MŒZT,BMŒZTRKD‚BB2˜UH˜GKVŠGOTONULLKAKIZAKIRATSTL,1‚MŒZTRB1NULLZE11NULL实验动物和分组NULL68ŸGKVŠSZLZžXLK430,S5F,F6,MŒZTSY1F›E‚ABROUXNULLENNULLY†Œ;2F›E‚ABT†Œ;3F›†SMABROUXNULLENNULLY†Œ;4F›†SMABT†Œ;1A3FBB†G„2A4FB†GYF{3CMB5F›E‚ABROUXNULLENNULLY†Œ,ŒBB†GYF{10CMB12NULL实验方法NULLVŠA‹,M†|BFBGAG›0KOGTTBŒJ,O75MGNULLKG1„5MGNULLKG18JBŒ436BŒ1A2A4A36SYM†|FBGAOGTTBFBGVŠJ1214HBSY10A30A60A120„180MINH,|ZEBP3„F˜NSURESTEPPLUS,LIFESCAN,JOHNSONJOHNSONB13NULL统计学处理NULLT”NULLSŸVUBFW1T_ZS;”‚˜†žŸZŸ5„_BSTATA70QBP005SD9ILB2NULLNULLNULLT21NULL各组术后血糖的变化NULLNV1BV1NULLFFBGMMOLNULLL1M1FYŒŒ4Œ361F161NULL6472NULL25NULL72NULL18NULL2F140NULL3096NULL2098NULL113F140NULL3578NULL2268NULL084F137NULL2591NULL2393NULL125F145NULL1572NULL0966NULL09NULLNULLŒM1,P005;2F1,NULLP00522NULL各组术后OGTT变化NULLNV2V3BV2NULLFOGTT‚MMOLNULLL1M1NULLXNULLSFYŒŒ361F319NULL15255NULL312F305NULL20275NULL353F305NULL33257NULL724F300NULL20276NULL445F309NULL20261NULL42NULLNULLŒM1,P005V3NULLFOGTT3HMMOLNULLL1M1NULLXNULLSFYŒŒ361F236NULL63155NULL172F244NULL54184NULL293F222NULL28160NULL214F231NULL38179NULL355F212NULL71150NULL22NULLNULLŒM1,P0053NULLNULLNULL‚UHRBŸHB,HY„H›†,ZE,SBŸZEBMSBRUBINO1VG—MŒRTI“4žMŒRE8“,P€2˜UHžREBHGMŒ,ŒO,G—2˜UH€RTKZB†VRTŸA,RUBINO3,ROUXNULLENNULLYSŒRYGB,ROUXNULLENNULLYGASTRICBYNULLPASS„‰OSŒBPD,BILIOPANCREATICDIVERNULLSION2˜UHRT1G—RTZ,Y7NULLUHMŒNULL†AB5DG—2˜UH€L,9|ERT4BFS59VGKVŠL†MŒ,JH,89FHB0ABYN,AŸŒ2˜UHRB”€4,6NULL7MŒ2˜UHMŒRT,7‚JH8HB1O›BT1LNULLLNULL443CHINESEJOURNALOFCLINICALMEDICINE,2010VOL17,NO3NULLNULLNULLS5DNULL2010M6NULL17NULL3NULLFOREGUTHYPOTHESIS„NULLLNULLHINDGUTHYNULLPOTHESISBLE7LO,HTO›†„S,V7\PO›†„DB,9FO›Ÿ8BRUBINO9C,†BB†9FY,Œ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