| Objective:To study the clinical effcet of gastric bypass surgery on patients with type 2 diabetes and compare the treatment effect of different styles of gastric bypass surgery on type 2 diabetic GK rats and try to explain the mechanisms.Methods:The documents of the patients who had been admitted into the department of general surgery of huashan hospital and undergone subtotal or total gastrectomy in the period of January 2004 to December 2008 were reviewed.If the patient was concurrent with type 2 diabetes,the blood glucose level postoperation was respectively compared with its own preoperative parameters and the dosage of hypoglycemic medication was analyzed. Thirty six male GK rats from six-week-age to eight-week-age were randomly divided into six groups,group 1 was operated by Roux-en-Y gastrojejunostomy with duodenum exclusion and stomach capacity maintenance, group 2 was operated by end-to-side gastrojejunostomy with duodenum exclusion and stomach capacity maintenance,group 3 was operated by Roux-en-Ygastrojejunostomy with partial gastrectomy,group 4 was operated by end-to-side gastrojejunostomy with partial gastrectomy. The length from jejunal anastomotic stoma to the ligament of Treitz in group 1 and 3 and the length from gastrojejunal anastomotic stoma to the ligament of Treitz in group 2 and 4 is 3cm,group 5 was operated as the same way as group l,but the length from jejunal anastomotic stoma to the ligament of Treitz is 10cm,group 6 was operated by the cutting off and re-suturation of the jiont of stomach and duodenum. Observed and recorded the changes of FPG,OGTT,GLP-1 and IGF-1 in different groups.Results:Among 12 patients after operation,7 patients had normal blood glucose without any hypoglycemic medication,2 patients had normal blood glucose with reduced dosage of hypoglycemic medication,3 patients had no improvement of blood glucose,the total effective rate is 75%. Group from 1 to 5 had good effect for controlling blood glucose except group 6,there was no patent difference between group 1 and 3 (P>0.05), as well as between group 2 and 4 (P>0.05),but group 1,3 and 5 were more effective than group 2 and 4 (P<0.05). The OGTT peak value at 36-week postoperation reduced in group 1 and 5 (P<0.05),but not in group 2,3 and 4 (P>0.05). The OGTT 3h level at 36-week postoperation had obvious improvement in group 1,3 and 5 (P<0.05),but not in group 2 and 4 (P> 0.05). Group 1 and 5 had good effect for controlling blood glucose (P<0.05),but there was no patent difference between the two groups (P> 0.05).There was also no patent difference in the OGTT peak value and the OGTT 3h level at 36-week postoperation between them (P>0.05). The GLP-1 value at 36-week postoperation increased in group 1 and 2 (P<0.05),but not in group 6 (P>0.05),the value was higher in group 1 than in group 2 (P<0.05). The IGF-1 level at 36-week postoperation increased in group 1 (P<0.01) and in group 2 (P<0.05), but not in group 6 (P>0.05),and there was no patent difference between group 1 and 2 (P >0.05).Conclusions:Gastric bypass surgery is effective to treat type 2 diabetes mellitus (T2DM),the Roux-en-Y gastrojejunostomy with duodenum exclusion and stomach capacity maintenance is a relatively perfect operative style for not only controlling blood glucose most effectively but also decreasing adverse effect of the body to the minimal level,further more, we should not increase the length of intestinal loop that excluded blindly, the GLP-1 and IGF-1 are important factors in the treatment of type 2 diabetic GK rats after gastric bypass surgery.
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