The Clinical Study Of Two Methods Of Laparoscopic Surgery For Obesity With Type 2 Diabetes

Background:With the improvement of social progress and living standards, and obesity-related type 2 diabetes mellitus(T2DM) has been popular in the world, a large number of clinical studies, the traditional treatment of T2 DM is difficult to achieve effective and lasting weight loss and remission The purpose of the disease. Surgical treatment of obesity and other merger T2 DM first seen Pories reported [1], they are morbidly obese patients with a "Y" gastric bypass(RYGB), weight loss surgery not only be satisfied with the results, but also found that the merger morbidly obese patients with T2 DM had reached 82.9% clinical complete remission of diabetes [2]. In recent years, the rapid development of T2 DM weight loss surgery, and laparoscopic technology matures and its dominant position, making our country more major clinical carried out earlier laparoscopic gastric bypass surgery(laparoscopic Roux-en-Y gastric bypass, LRYGB), and laparoscopic sleeve gastrectomy(laparoscopic Sleeve Gastrectomy, LSG) over the years has also been favored domestic weight loss physicians, the advantage of the technical operation is relatively simple, does not alter the normal physiological state of the gastrointestinal tract. The principle can be divided summarized as follows: 1, limiting food intake, 2, reducing the absorption of nutrients, 3, by changing the physical structure of the gastrointestinal tract to affect the gut hormones. But the exact mechanism is not clear. In addition, weight loss surgery, and analysis of the efficacy of T2 DM, there are differences in terms of ease of surgical procedures and the occurrence rate of postoperative complications, obesity with how to select the appropriate type 2 diabetes appropriate individualized surgical also needs more clinical research evidence.Objective:bservation and underwent LRYGB LSG obesity indicators before and after the merger lipid metabolism in type 2 diabetes surgery, weight and nutritional changes, insulin function and insulin resistance, changes in gut hormones and treatment, laparoscopic weight loss surgery possible mechanisms of T2 DM, compared to two kinds of surgical safety and efficacy, select the appropriate surgical patients to provide the basis for a different disease.Method: retrospective analysis from February 2011 to May 2012 in Tianjin Traditional Chinese Medicine Hospital 66 cases of obese patients with type 2 diabetes information, in accordance with the operation mode is divided into: LRYGB group(40 cases) and LSG group(26 cases). Patients were followed up for at least 24 months before and after surgery glucose and lipid metabolism(fasting glucose, 2-hour postprandial glucose, fasting C-peptide, Hb A1 C, total cholesterol, triglycerides), changes in body weight and nutrition(BMI, waist circumference, EWL% hemoglobin, total protein, albumin), insulin function and insulin resistance mutations(Homa-IR, Homa-β), gut hormone changes(GLP-1, Ghrelin) and the therapeutic effect, compared to the above two kinds of surgical operation operating time, postoperative hospital stay, incidence of postoperative complications, such as assessing the safety of surgery. Each set of data are expressed as mean ± standard deviation. Using SPSS 17.0 statistical software for statistical analysis.Result:mprovement in glucose and lipid metabolism:Glucose metabolism: compared with the preoperative, LRYGB group and the LSG group 1 and 3 months after surgery, fasting glucose, 2h postprandial blood glucose, Hb A1 c significantly decreased(P <0.01), after 6,12,18 months of steady decline(P <0.05), but the difference was not statistically significant(P between groups> 0.05);Lipid metabolism: the first two groups of patients after surgery was significantly lower than those in serum lipid levels(P <0.05); LRYGB group and the steady decline in the LSG group 1,3,6,12 months after surgery, the remaining time between groups was not statistically significance(P>0.05). body weight and nutritional changes:Compared with the preoperative compared with the preoperative and postoperative 1,3,6,12 months BMI was significantly lower(P <0.05), after 12 months to 24 months, the patient BMI stabilized, the difference was not statistically significant. the total protein and albumin levels did not change significantly, the total protein in only six months after surgery, when compared with the preoperative difference was statistically significant(P <0.05), but still within the normal reference range within; after one month to six months, both groups of patients compared with preoperative hemoglobin levels were lower(P <0.05), 6 months after the hemoglobin levels stabilize, the normal reference range, significant anemia does not appear. insulin resistance and islet functionchanges:LRYGB LSG group after group and insulin resistance(Homa-IR) than before surgery significantly improved(P <0.05). LRYGB group after one month of islet function(Homa-β) that is significantly improved compared with before surgery(P <0.05), whereas no significant improvement LSG group(P> 0.05); 6,12,18,24 months after surgery LSG previous month, compared with the preoperative group improved significantly(P <0.05), compared with between-group differences LRYGB group was statistically significant(P <0.05).treatment of type 2 diabetes:LRYGB group of 40 patients after 24 months, 27 cases of complete remission(67.5%), partial remission in 7 cases(17.5%), clinical improvement in 6 cases(15%), 40 cases of all effective treatment. 34 cases(85%) Disable insulin or hypoglycemic, 6 cases(15%) and oral hypoglycemic agents are deactivated insulin, including 5 cases(12.5%) oral medication halved 1 case(2.5%) oral only acarbose. 40 patients had no recurrence, until after 24 months of treatment effect remained stable; LSG group patients were 17 cases of complete remission at 24 months(65.4%), 4 cases of partial remission(15.4%), 5 patients Disable insulin and oral medications in half(19.2%), while there is also a 100% efficiency, remained stable after 2 years. Using Fisher’s exact test comparing two groups of patients after surgery type 2 diabetes remission rate, the difference was not statistically significant(P = 1.000> 0.05)Conclusion: ① LRYGB and LSG is a merger of two effective surgical treatment of obesity with type 2 diabetes, type 2 diabetes have a higher response rate.② LRYGB for the treatment of obesity and diabetes may be superior to the therapeutic effect of LSG, especially type 2 diabetes for a long time, the use of hypoglycemic dose of medication in patients with high ratios. However LSG relatively simple, without changing the physiological state of the gastrointestinal tract, high security. ③ LSG is more applicable to the symptoms of obesity, diabetes, lighter, younger, less damage islet function preoperative patients. Also, if the poor postoperative results LSG will be diverted LRYGB or biliopancreatic bypass(DBP).