Impact Of3Kinds Of Digestive Tract Reconstruction On Carbohydrate And Lipid Metabolism In Non-obese Type2Diabetes Mellitus Patients

Objective:To evaluate3kinds of digestive tract reconstruction in carbohydrate and lipid metabolism in non-obese type2diabetes mellitus (T2DM) patients.Methods:Clinical data of39cases in whom Billroth I anastomosis (10cases), Billroth II anastomosis (13cases) and Roux-en-Y anastomosis (13cases) was performed by a group of surgeons in the Department of General Surgery, Gansu Provincial People’s Hospital from February2009to May2011were reviewed. Clinical outcome were assessed and compared between the three groups. Documenting each patient’s name, age, sex, history of diabetes,history of hypertension, a history of hyperlipidemia, preoperative blood glucose and lipids drug application situation and the surgical approach. All the patients Preoperation,6months after operation and12months after operation at each time point fasting blood glucose (FPG), Glycosylated hemoglobin (GHbAlc), Fasting c-peptide (FCP), Fasting Insulin (FINS), Triglyceride (TG), Total cholesterol (TC), Low density lipoprotein (LDL), High-density lipoprotein (HDL).Results:All patients recovered without major complications. Serum levels decreased in pre-operative and post-operative were FPG, GHbAlc, TG, TC and LDL-c were respectively (2.6±0.7) mmol/L、(2.1±0.7)%、(1.5±0.5) mmol/L、(0.8±0.3) mmol/L and (1.0±0.4) mmol/L. Postoperative levels of HDL, FINS and FCP were significantly higher than that of the pre-operative values were respectively (0.3±0.07) mmol/L、(6.1±3.2) mU/L、(0.28±0.06) nmol/L. On the other side, the FPG, GHbAlc, TG and LDL in Roux-en-Y anastomosis group were much lower than that in other two groups (P<0.05). The difference mainly reflected in Roux-en-Y anatomosis group(t≥2.012,P<0.01). But the effect of the FBG、bAlc、FINS、TG、LDL was statistically significant difference between the Billroth I anastomosis group and the Billroth II anatomosis group. Postoperative patients with review of carbohydrate and lipid in without any drug treatment and special diet,Billroth I anastomosis, Billroth II anastomosis and Roux-en-Y anastomosis to improve the patient glycolipids anomaly of the effective rate was40%,69.2%and81.3%.Conclusion:Improves of3Kinds of Digestive Tract Reconstruction of carbohydrate and lipid in non-obese T2DM patients, and the mechanism remains unclear. The Billorth II anastomoses and Roux-en-Y anastomoses may be better at Control blood glucose and reduce the overall efficacy of lipid for the gastric patients with diabetes mellitus. May be associated with the adjustment of the postoperative gastrointestinal hormone to secrete, but the mechanism still needs further research, for clinical provides the theory basis of surgical treatment for Diabetes Mellitus.