The Study Of Clinical Effects And Mechanism Of Laparoscopic Single Anastomosis Duodeno-jejunal Bypass With Sleeve Gastrectomy For Non-obesity Type 2 Diabetes

Objective To evaluate clinic effect and glycolipid metabolic mechanism of Laparoscopic single anastomosis duodeno-jejunal bypass with sleeve gastrectomy(SADJB-SG)on type 2 diabetes mellitus(T2D)and investigate the reasonable selection of surgical type on type 2 diabetes mellitus with low body mass index.Material and Methods The clinical data of 14 patients of T2D with 25<BMI<27.5 between Aug.2013 and Aug.2015 in General Hospital of Guangzhou Military Command of PLA were analyzed retrospectively.The patients by the procedure they underwent and analyzed the physical index,glucose metabolism index.The GK rats were randomized divided into two groups(11 in SADJB-SG group and 6 in sham group)by the procedure they underwent.Results Operations were successfully performed in all the 14 patients with no mortality.During 1 year after operation,there were significant improvement about weigh,BMI,glycated hemoglobin(HbAlc),fasting plasma glucose(FPG),oral glucose tolerance test 2 hours(OGTT2h),fasting insulin(FINS)in DJB group(P<0.05).There are no complications.The total mortality of two groups was 29.41%(5/17)at 8 weeks after the operation,of which 7 were alive in group DJB and 5 in the control group.In group DJB,1,4,8 weeks after operation,the food intake was significantly lower than that in the sham group(P<0.05),and the weight of the group was significantly lower than the sham group at 2-8 weeks after the operation.Group DJB after 5,7,8 weeks fasting blood glucose significantly decreased compared to the sham group(P<0.05);after 1,2 and 4-8 weeks of non-fasting blood glucose significantly decreased compared to the sham group(P<0.05);at 8 weeks after surgery and preoperative postoperative hemoglobin increased but no significant difference(P>0.05),but the sham group after 8 weeks were significantly higher than before(P<0.05).The glucose tolerance test in group DJB was significantly lower than that of the sham group(P<0.05)8 weeks after operation(P<0.05).The peak of blood glucose secretion curve in the sham group was more than that of the DJB group.In group DJB,HOMA-IR was significantly lower than the sham group(P<0.05)at 4,8 weeks after operation(P<0.05)and decreased to less than lweek.Group DJB,leptin,ghrelin,glucagon like peptide-1 at 1,4,8 weeks after operation compared with the sham group decreased significantly(P<0.05),glucagon in 2,4,8 weeks after operation compared with the sham group decreased significantly(P<0.05),plasminogen activator inhibitor-1 on postoperative 1,2,4,8 the week is significantly less than the control group(P<0.05).In group DJB,visceral fat content decreased significantly at 8 weeks after operation(P<0.05),and the upper abdominal subcutaneous fat was significantly reduced(P<0.05),while visceral fat in the lower abdomen decreased significantly(P<0.05).Conclusion SADJB-SG is effective in the treatment of non-obese T2D.After SADJB-SG of GK rats,the surgical effect of SADJB is definite.It can obviously improve blood sugar,alleviate insulin resistance,reduce abdominal visceral fat content,and change the level of glucohormone related hormones in the body.