| Diabetes mellitus (DM), a kind of metabolism disease whose serum glucose's level increase chronicly. type 2 diabetes mellitus(T2DM) is most common type in DM, which is about 80%-90% in primary DM. The happen of T2DM ascribe to the oversecretion ofβcell which leads to hypofunction or low reaction to the glucose regulation.All these agents make body cann't produce enough insulin, which is near to insulin's relative deficient.This kind of situation often happens in the persons who always keep a high amount of ingestion .The state of hyperglycaemia can stimulateβcell continuely,which results to hyperinsulinemia. If this kind of state last too long, the target organ of insulin, for example: liver, muscle, adipose tissue and so on, whose receptor's function will decrease.Even worse condition is that the amount of the receptor will also decrease, the regulation function is injured, the function of insulin hormones decrease, and at the same time the target organs'reaction sensitivity to insulin was descreased, this is called"insulin resistance, IR". IR can aggravate insulin's relative deficient. As a result of what we have said,"glucose toxicity"is admitted by most people.About 85% T2DM happens in the people who are obesity.The serum insulin of them are normal or decrease lightly.Certainly,there are also some T2DM patients who are young and are non-obese. This may have some to do with the heredity and genes. The main therapy for T2DM nowdays are some internal medical treatment, including alimentary control, sports, improve life style, oral antidiabetic drug and insulin injection,but all of them's therapeutic efficacy are not significant,and they can lead to the low levels of life quality easily. Pancreas transplant and islet cell transplant are confined in the clinical use because of graft rejection, the side effect of immunodepressant, the complications of operation, and so on.In 1950s, bariatric operation began to be used in morbid obesity's control. At first, the clinical analysis found the obvious amelioration of T2DM, who also have morbid obesity, after the operation.But this didn't get a highly think until Pories proved that the operation could improve the morbid obesity patients'T2DM. There are significant differences between different ways of bariatric operation s'effects on T2DM. Among them, gastric bypass(GBP) is the most effective one. Nowadays, America and Europe have been using GBP operation as a major therapy for the T2DM patients who have morbid obesity at the same time.We reviewed the clinical information of the non-obese gastric carcinoma or periampullary carcinoma patients who were in our hospital from January, 2005 to January, 2008, And at the same time, were complicated with T2DM. They all accept the different ways of enteron rebuild. We analyzed their levels of serum glucose and insulin dosage.Objective To research the effect of Enteron rebuild after Gastrectomy on Type II diabetes mellitus (non-insulin -dependent diabetes mellitus, NIDDM).Methods 1. Diagnostic criteria for type2 diabetes mellitus: ADA(American Diabetes Association's criteria 2006): A fasting plasma glucose level of 126 mg/dL(7.0mmol/L) or greater on at least two occasions; A random plasma glucose level of 200 mg/Dl (11.1mmol/L); or the patients have classic signs and symptoms of diabetes mellitus, including poly- dipsia,polyuria, polyphagia, and weight loss,and still accepting medical therapy,even if their plasma glucose's levels are normal,we can also make the diagnosis of T2DM.2. Demographic Data :Make a record of every patients'preoperation and postoperation fasting plasma glucose, postprandial plasma glucose and the dosage of the insulin they have been used. Then make a comparison between pre- operation and postoperation fasting plasma glucose, postprandial plasma glucose and the nsulin dosage respectively.The comparision time is 1 week,1 month and 2months.3. statistical method: The t test was used in the comparison between preoperation and postoperation's fasting plasma glucose and postprandial plasma glucose.p<0.001 means significant between two data.We used SPSS v 13.0 to finish the t test.Result: 1.The comparison of fasting plasma glucose1.1 Group B I Level of pre-operation fasting plasma glucose is 10.20±2.18mmol/L; Level of fasting plasma glucose 1 week after the operation is 10.40±1.63mmol/L. Level of fasting plasma glucose 1 month after the operation is 10.00±1.9 7mmol/L. Level of fasting plasma glucose 2 months after the operation is 9.94±2.11mmol/L.There is no significant differences between pre-operation and post- operation levels of fasting plasma glucose (P>0.05)1.2 Group whippleLevel of pre-operation fasting plasma glucose is 8.23±1.38mmol/L; Level of fasting plasma glucose 1 week after the operation is 8.21±1.29mmol/L. Level of fasting plasma glucose 1 month after the operation is 5.63±0.62mmol/L. Level of fasting plasma glucose 2 months after the operation is 5.48±0.58 mmol/L.There is no significant difference between the level of fasting plasma glucose pre-operation and 1 week after the operation (p>0.05). There is a significant difference between the level of fasting plasma glucose pre-operation and 1 month, 2 months after the operation (p<0.001).1.3 Group total- gastrectomyLevel of pre-operation fasting plasma glucose is 8.07±1.74mmol/L; Level of fasting plasma glucose 1 week after the operation is 8.02±1.78mmol/L mmol/L. Level of fasting plasma glucose 1 month after the operation is 6.20±1.33mmol/L. Level of fasting plasma glucose 2 months after the operation is 6.00±1.09mmol/L.There is no significant difference between the level of fasting plasma glucose pre-operation and 1 week after the operation (p>0.05). There is a significant difference between the level of fasting plasma glucose pre-operation and 1 month, 2 months after the operation (p<0.001).2. The comparison of postprandial plasma glucose2.1 Group B ILevel of pre-operation postprandial plasma glucose is 15.18±4.64mmol/L; Level of postprandial plasma glucose 1 week after the operation is 14.81±3.46 mmol/L. Level of postprandial plasma glucose 1 month after the operation is 14.51±4.30mmol/L. Level of postprandial plasma glucose 2 months after the operation is 14.10±3.70 mmol/L.There is no significant differences between pre-operation and post- operation levels of postprandial plasma glucose (P>0.05).2.2 Group whippleLevel of pre-operation postprandial plasma glucose is 12.79±0.63mmol/L; Level of postprandial plasma glucose 1 week after the operation is 12.53±0.74 mmol/L. Level of postprandial plasma glucose 1 month after the operation is 10.47±1.36mmol/L. Level of postprandial plasma glucose 2 months after the operation is 10.71±1.44mmol/L.There is no significant difference between the level of fasting plasma glucose pre-operation and 1 week after the operation (p>0.05). There is a significant difference between the level of fasting plasma glucose pre-operation and 1 month,2 months after the operation (p<0.001).2.3 Group total- gastrectomyLevel of pre-operation postprandial plasma glucose is 13.90±1.78mmol/L; Level of postprandial plasma glucose 1 week after the operation is 13.57±1.47 mmol/L. Level of postprandial plasma glucose 1 month after the operation is 10.62±1.18mmol/L. Level of postprandial plasma glucose 2 months after the operation is 10.75±1.25mmol/L.There is no significant difference between the level of fasting plasma glucose pre-operation and 1 week after the operation (p>0.05). There is a significant difference between the level of fasting plasma glucose pre-operation and 1 month,2 months after the operation(p<0.001).3. The comparison of insulin dosage3.1 Group B IIn group B I, there were 5 cases needed insulin injection before operation.After operation,2 of the 5 didn't need insulin injection any more. 1 case's dosage of insulin decreased.2 cases'dosage of insulin increased.3.2 Group whippleIn group whipple, there were 6 cases needed insulin injection before operation. After operation, 2 of the 6 didn't need insulin injection any more.Another 4 cases'dosage of insulin decreased.3.3 Group total- gastrectomy In this group, there were 4 cases needed insulin injection before operation. After operation, 2 of the 4 didn't need insulin injection any more. Another 2 cases'dosage of insulin decreased.Conclusion: Both Whipple and total gastrectomy operation reduced the non-obese T2DM patients' plasma glucose levels and dosage of insulin injection.The effect of Radical gastrectomy B I anastomosis on non-obese T2DM patients is not significant.The effect of Enteron rebuild after Gastrectomy on T2DM is significant. It is believed that GBP will be the major way to cure T2DM not far from now. There is a significant difference between whipple operation, total gastrectomy and Radical gastrectomy B I anastomosis.The difference is that the uncompletely digestive food get into ileum prematurely, this indicate that"enteron bypass"plays an important role in the mechanism of the cure of T2DM. Duodenum and proximal jejunum are the most important parts of the mechanism of T2DM's cure. All of above may have something to do with some neuroendocrine factors. What these factors are? How they are working? It still need deeper research.
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