The Analysis Of The Feasibility And Curative Effect About LRYGB On Non-obese Type2Diabetes

Objective To observe the effect and feasibility of laparoscopic gastric bypass operationon non-obese type diabetes patients. Method According to the inclusion and exclusioncriteria,16cases of patients with type2diabetes were selected and acceptedlaparoscopic gastric bypass treatment. According to BMI the patients with type2diabeteswere divided into two groups: Group A,8patients without obesity (BMI <30kg/m2)and Group B,8with obesity (BMI＞30kg/m2). Two groups of patients got the samegastric bypass surgeries. Namely a gastric pouch about100ml from proximal gastric wasseparated with closure devices and the jejunum was cut off at around100cm from Trietzligament. And the anastomosis was adopted between distal jejunum and the small gastricpouch mentioned above. Then intestinal jejunostomy was carried out at around100cmfrom the first stoma so that the Roux-en-Y gastric bypass was formed. By comparing therelative diabetic indexes of Group A and B (fasting blood glucose, Oral glucose tolerancetest,glycosylated hemoglobin, C peptide and serum insulin) preoperatively andpostoperatively (2months after the surgery), the clinical efficacy of gastric bypasssurgery to T2DM were estimated, the gastric bypass surgery was effective in both groupand the efficiency was compared in the two groups. Results (1) Of all the16patients,the postoperative hemoglobin(2months after the surgery) decreased by comparing withthe preoperative indexes and blood glucose values in each phase of OGTT got lower thanthe preoperative indexes. So the glucose metabolism of2months after the operationwas significantly improved.The results of C peptide,the insulin stimulation and releasingtests showed that the values of C peptide, insulin secretion and stimulated secretionincreased after the surgery. It indicated that the function of insulin was enhanced.(2)During the fllow-up visit to the16patients,1case of adhesive intestinal obstructionhappened after operation,2case of malnutrition and hypoferremia disease occurred andno denths occurred. Conclusions (1) The laparoscopic gastric bypass is effective for thetreatment of type2diabetes with obesity, and the glucose metabolism can be improvedmarkedly. HbA1c and C peptide are improved too.(2) The surgery is an effective treatment for non-obese type2diabetic.(3) The laparoscopic gastric bypass surgery hasthe advantages of high safety for patients with type2diabetes.（4）The operation in thetreatment of type2diabetes patients with obesity is better than the non-obese type2diabetes mellitus.