Research On Clinical Results And Effect Factors Of Gastric Bypass On Relieving Type2Diabetes Mellitus

At present,in the world scope the prealence of diabetes is increasing year byyear,it became the third big serious human health of chronic non-communicablediseases after cerebrovascular disease and tumor.More than90%of diabetes aretype2diabetes mellitus,traditional medical treatment can only control bloodsugar, can’t fundamentally relieve condition and its complications, and bring therisk of side effects of glucose-lowering drugs.Gastric bypass flow direction fromsurgery to find treatment method for diabetes, and has opened up a new field forpeople to conquer diabetes and other metabolic diseases.Objective:1.The experiment research the clinical results of gastric bypass onrelieving type2diabetes mellitus, and discuss the efficacy of surgical treatment.2.The experiment research effect factors of gastric bypass on relieving type2diabetes mellitus,and provide clinical evidence to make surgicalindications of gastric bypass.Method:Clinical data of domestic three diabetes surgery centers for operatinggastric bypass in patients with type2diabetes mellitus areretrospectively,contrastively studied,comparing the preoperative andpostoperative related index changes, between preoperative results changes of twogroups,and postoperative results changes of two groups,analyzing clinical resultsand various effect factors of gastric bypass.Result:1.Type2diabetes mellitus are completely relieved and improved in threediabetes surgery centers for operating gastric bypass,and no seriouscomplications.2.FPG[(7.8±2.2)mmol/L,(7.7±2.2)mmol/L,(7.2±1.8)mmol/L] of1,6,12month after operation of32patients of type2diabetes mellitus were severallylower than FPG[(11.1±2.7)mmol/L] of Preoperation,and statistically significantdifference(P<0.05).2hPG[(10.2±2.6)mmol/L,(10.5±2.8)mmol/L,(10.5±3.1)mmol/L]of1,6,12month after operation of32patients of type2diabetes mellitus wereseverally lower than2hPG[(14.0±3.5)mmol/L] of Preoperation,and statisticallysignificant difference(P<0.05).HbA1c[(7.6%±1.4),(7.5%±1.7),(7.1%±1.9)]of1,6,12month after operation of32patients of type2diabetes mellitus were severallylower than2hPG[(9.0%±2.3)] of Preoperation,and statistically significantdifference(P<0.05).There were no statistically significant difference betweenBMI[(23.4±3.9)Kg/m~2,(23.6±4.3)Kg/m~2,(23.5±4.1)Kg/m~2] of1,6,12month afteroperation of32patients of type2diabetes mellitus and BMI[(25.2±4.0)Kg/m~2] ofpreoperation(P>0.05).There are only3cases(9.4%) of obese patients of BMI≥30Kg/m~2in32patients of type2diabetes mellitus,and29cases of non-obesepatients of BMI<30Kg/m~2.FPG[(6.9±1.5)mmol/L],2hPG[(10.0±3.2)mmol/L], HbA1c[(6.9%±1.9)] of12month after operation of19non-overweight patientswere severally lower than FPG[(10.7±2.9)mmol/L],2hPG[(14.3±4.1)mmol/L],HbA1c[(8.8%±2.0)] of Preoperation,and statistically significant difference(P<0.05).There were no statistically significant difference betweenBMI[(21.4±2.0)Kg/m~2of12month after operation of19non-overweight patientsand BMI[(22.7±2.0)Kg/m~2] of preoperation(P>0.05).The operating time[(2.2±0.4)h] of the open group(27cases) were less than the operation time[(3.4±0.5)h]of the laparoscopic group(5cases),and statistically significant difference(P<0.05).The hospital stays [(15.1±6.9)d] of the open group(27cases) were longer than thehospital stays[(10.0±1.8)d] of the laparoscopic group(5cases),and statisticallysignificant difference(P<0.05).3.There were no statistically significant difference between the opengroup(27cases) and the laparoscopic group(5cases) in preoperative age[(49.1±7.9)Y,(41.2±12.4)Y,P>0.05],gender[(13/14)man/woman,(3/2)man/woman,P>0.05],medical history[(7.9±3.8)Y,(5.6±3.6)Y,P>0.05],FPG[(11.1±2.8)mmol/L,(11.3±2.3)mmol/L,P>0.05],2hPG[(14.2±3.7)mmol/L,(12.8±2.4)mmol/L,P>0.05],HbA1c[(9.1±2.0)%,(8.3±3.7)%,P>0.05],BMI[(24.2±3.0)Kg/m~2,(30.4±9.6)Kg/m~2,P>0.05].There were no statistically significant difference between the open group(27cases) and the laparoscopic group(5cases) in postoperative result[(7/27)%,(2/5)%,P>0.05] after12months.Preoperative age[(42.9±10.0)Y],medicalhistory[(5.2±3.4)Y],FPG[(8.8±1.2)mmol/L],2hPG[(11.6±2.4)mmol/L],HbA1c[(7.4%±1.5)] of complete remission group(9cases) was smaller than preoperativeage[(49.8±8.0)Y],medical history[(8.4±3.9)Y],FPG[(12.0±2.5)mmol/L],2hPG[(15.0±3.5)mmol/L],HbA1c[(9.6%±2.3)] of non-complete remission group(23cases),and statistically significant difference(P<0.05).There were no statisticallysignificant difference between the complete remission group(9cases) and the non-complete remission group(23cases) in gender[(7/2)man/woman,(9/14)man/woman,P>0.05],preoperative BMI[(24.6±2.1)Kg/m~2,(25.4±4.5)Kg/m~2,P>0.05].There were no statistically significant difference between the group(5cases) ofbig residual gastric pouch and the group(11cases) of small residual gastric pouchin preoperative age[(41.2±12.4)Y,(51.4±14.1)Y,P>0.05],gender[(3/2)man/woman,(5/6)man/woman,P>0.05],medical history[(5.6±3.6)Y,(6.3±3.5)Y,P>0.05],FPG[(11.3±2.3)mmol/L,(11.3±2.7)mmol/L,P>0.05],HbA1c[(8.3±3.7)%,(8.7±2.7)%,P>0.05],BMI[(30.4±4.8)Kg/m~2,(28.6±5.5)Kg/m~2,P>0.05].Postoperative result[(9/11)%] of the group(11cases) of small residual gastric pouch was better thanthat[(1/5)%] of the group(5cases) of big residual gastric pouch,and statisticallysignificant difference(P<0.05). There were no statistically significant differencebetween the normal group(23cases) and the obese group(5cases) in preoperativeage[(49.2±7.9)Y,(42.2.4±4.4)Y,P>0.05],gender[(11/12)man/woman,(4/1)man/woman,P>0.05],medical history[(7.6±3.7)Y,(4.4±1.1)Y,P>0.05],FPG[(11.0±2.9)mmol/L,(10.2±2.2)mmol/L,P>0.05],HbA1c[(9.0±2.0)%,(8.5±1.0)%,P>0.05].TheBMI[(23.3±2.3)Kg/m~2] of the normal group(23cases) were less than theBMI[(32.3±5.3)Kg/m~2] of the obese group(5cases),and statistically significantdifference(P＜0.05).Postoperative result[(5/5)%] of the obese group(5cases) wasbetter than that[(7/23)%] of the normal group(23cases),and statisticallysignificant difference(P<0.05).Conclusions:1.Gastric bypass can completely remit and improve type2diabetesmellitus significantly,and the non-obese(non-overweight) patients after gastricbypass will not reduce weight or become thin.The laparoscopic gastric bypass isbetter than the open gastric bypass in minimally invasive operation.Gastricbypass also reduce high blood pressure,completely remit and improve fatty liver.2.The results after gastric bypass are better,if the patients of type2 diabetes mellitus have less age,shorter medical history,obesity(BMI≥28Kg/m~2),better glycemic control of preoperation,normal function of islet cell,and acceptoperation of small residual gastric pouch.