| Background Currently, the prevalence of obesity and obesity-related type2diabetesmellitus (T2DM) is increasing worldwide. The conventional therapy for obesity and T2DMcould not receive constant remission. The surgical therapy of T2DM was reported firstly byPories et al. They found that82.9%of T2DM patients with morbid obesity were resolutionwho underwent Roux-en-Y gastric bypass (RYGB). Bariatric surgery was developedrapidly in T2DM treatment recently. The main means include Roux-en-Y gastric bypass(RYGB), mini-gastric bypass (MGB), biliopancreatic diversion (BPD), sleeve gastrectomy(SG) and adjustable gastric banding (AGB). Their curative effect of T2DM are supportedby a number of clinic researches. The possible principles of T2DM surgical treatmentincludes decreasing food intake, partial malabsorption of nutrients and anatomicalalteration of gastrointestinal tract, which incites changes in the incretin system, but thedefinite machanisms are not clear. Besides, there are different effects of morbid obesity andT2DM, degree of difficulties, incidence rate of complications and so on. Therefore, moreclinical studies are required to choose the right surgical way for T2DM patients withobesity.Objective The purpose is to discuss the possible mechanism and right surgical operationof T2DM surgical treatment, compared changes of diabetes-related metabolic indicator,security of surgery and the T2DM therapeutic efficacy among4modes of bariatric surgery(LRYGB, LMGB, LSG, LAGB).Methods This research involved44obese patients with T2DM, who were divided intofour groups, and underwent LRYGB (n=14), LMGB (n=11), LSG (n=9), LAGB (n=10)respectively, from March2010to August2011. Every patients would undertake oversix-month period postoperative follow-up. Perioperative data were assessed. Theparameters involving T2DM resolution rate, waist circumference, BMI, HOMA-IR,HhA1C, GLP-1, Ghrelin, operative time, postoperative stay, complication rate, ect. weremeasured.Results The levels of waist circumference, BMI, HOMA-IR and HbA1C within thepostoperative6months were improved respectively in each group (P<0.05), there were nointeraction between postoperative days and the modes of operation in four groupsrespectively (P>0.05). The study suggest that effects of the different operative modes onwaist circumference, BMI, HOMA-IR and HbA1C were no significant difference. The changes in level of fasting GLP-1and Ghrelin among four groups were different(P<0.05), there were interaction between postoperative days and the operative modes(P<0.05). Compared to preoperative level, fasting GLP-1in LRYGB and LMGB groupwas higher in the first and sixth month after surgery (P<0.05). The changes in level of LSGand LAGB group were no significance (P>0.05). The level of fasting Ghrelin in LRYGB,LMGB, LSG group at the end of the first week after surgery were lower than preoperative(P<0.05). The postoperative level of fasting Ghrelin was higher in LAGB group (P<0.05).But the level of Ghrelin in LRYGB and LMGB groups rebounded in the first and sixthmonth, wheras it didn’t rebounded in the LSG group. The level of Ghrelin in LAGB groupafter surgery was higher than peroperative level (P<0.05). There were no significantdifference between LRYGB and LMGB (P=0.325).The clinical complete remission rate of T2DM were78.6%,72.7%,66.7%,30.0%inLRYGB, LMGB, LSG, LAGB group respectively. The clinical partial remission rate ofT2DM were21.4%,27.3%,22.2%,40.0%respectively. The inefficacy rate is11.1%,30.0%in LSG and LAGB group respectively. The curative effects of surgery on T2DMwithin6monthes after surgery among four groups were different (χ2=8.16，P=0.043), theeffects of LRYGB and LMGB group were better than LAGB group (P=0.006，0.018).There were no mortality and conversion in all groups. The mean operative time andpostoperative stay of LRYGB, LMGB, LSG, LAGB (155.1min,121.4min,116.2min,71.7min,8.6d,6.9d,5.7d,2.9d, P<0.05) were different, LRYGB group was longest andLAGB group was shortest among four groups. There were on significant in complicationrate among four groups (χ2=0.777，P=0.855), but complications in LRYGB and LMGBgroups were more serious.Conclusions The four modes of laparoscopic bariatric surgery are available to treatT2DM, but the efficacy and security of the modes of surgery are different. LRYGB andLMGB groups got the best therapeutic efficacies, but their operative risk are highest. Whilethe efficacy of LAGB is lowest, which is safest way among four operative modes. Themechanism in four modes are different, GLP-1is increased after LRYGB or LMGB,Ghrelin is reduced after LSG. Changes in gut hormones after bariatic could influence theeffects of surgeries, besides decreasing food intake or partial malabsorption of nutrients.LRYGB and LMGB are more appropriate to cure T2DM patients with obesity, LSG andLAGB could be chose to the mild T2DM patients with obesity, who would accept the riskof LRYGB or LMGB. |
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