| The prevalence of diabetes mellitus was 9.7% in the population over the age of 20 in China, and the total number of patients was as high as 92 million 400 thousand, ranking the first in the world, of which type 2 diabetes mellitus (T2DM) accounted for 90%. As a traditional medical treatment of disease, T2DM now can be improved by surgery. The Roux-en-Y gastric bypass (RYGB) was regarded as the treatment of choice for T2DM in the American Diabetes Association. As a new independent bariatric surgery, Sleeve gastrectomy (SG) are more and more widely used in the world, because of its low operation difficulty and fewer complications. As the number of SGs is increasing, the surgeons' viewpoint of SG changes from bariatric surgery to metabolic surgery. However,when compared with RYGB, which is regarded as the "gold standard" in metabolic surgery, the effect of SG on improving metabolic symptoms and weight loss is seemingly imperfect. Therefore, more and more surgeons choose to add bypass to SG in the first stage.Single-Anastomosis Duodenal - Jejunal Bypass with Sleeve Gastrectomy (SADJB-SG) was first be introduced in 2013 by the Asian surgeon. Studies improved that SADJB-SG can improve obesity and T2DM in short term. SADJB-SG has the following advantages: (1) When been compared with RYGB, SADJB-SG can avoid the occurrence of gastric stump cancer. (2) SADJB-SG can be regarded as a simplified biliopancreatic diversion with duodenal switch (BPD/DS), taking into account the sleeve gastrectomy advantage and foregut theory "and" hindgut theory". (3) RYGB and BPD/DS all han two anastomotic. SADJB-SG has only one anastomotic, which can reduce the operation difficulty and complications.This study intends to establish a reliable rat model of SADJB-SG. Based on this model we can further improve the effect of SADJB-SG on obesity and T2DM, and explore the changes of gastrointestinal hormones such as ghrelin and GLP-1.Party I Single Anastomosis Duodenal Jejunal Bypass with Sleeve Gastrectomy in ratsObjective To establish a safe and reliable SADJB-SG rat model on the basis of SG rat model and select the duodenal jejunal anastomosis which under Treitz ligament 10cm,20cm or 30cm.Materials and methods One hundred Sqrague-Dawley rats (SD rats), 6 weeks old,weight 150-180g, average body weight 173.66±13.73g, were randomly divided into normal diet group (NF group), n=20, average body weight 174.98 + 14.36g, high fat and high glucose diet group (HF group), n=80, average body weight 173.33 + 13.164g, no statistical difference between the two groups (P >0.05). All rats were fed for 8 weeks. The rats in HF group which weight was higher 20% than that of group was defined as obese rats. In the end, a total of 70 rats were obese rats. Noninsulin-dependent diabetes mellitus was induced in overnight-fasted rats by a single intraperitoneal (i.p.) injection of 45 mg/kg streptozotocin. Blood glucose was measured from the tail vein once daily within 3 days after injecting streptozotocin. Only rats with an average blood glucose concentration >16.7 mmol/L were included as successful T2DM models. Of all rats, 61 rats were confirmed to be the successful model, corresponding to a rate of 76.25%. Excluding the death of rats after surgery, the rats were divided into 5 groups: control group (SO) n=10,SG group n=10, SADJB-SG groups n= 30, according to the position of the duodenal anastomosis was divided into SA10 group n=10, SA20 group n=10 and SA30 group n=10.Result There were 12 rats in group SG with a total survival rate of 83.33%. There were 39 SADJB-SG rats in SADJB-SG groups with the survival rate of 76.92%. The operation time of SG group, SA10 group, SA20 group and SA30 group were 52.4±5.44min,69.2±5.41min,68.7±5.74min ? 68.2±5.55min, SG group was significantly lower.(P <0.05).Conclusion In this study, we successfully established a rat model of obesity T2DMrat and SADJB-SG rat model, and we can further study the effect of obesity and T2DM with these models.Party II Study on Single Anastomosis Duodenal Jejunal Bypass with Sleeve Gastrectomy in obesity type-2 diabetes ratsObjective To explore the effect of SADJB-SG on obesity T2DM rats.Materials and methods Fifty obesity T2DM rats (SD rats fed with high fat and high glucose diet and intraperitoneal injection streptozotocin) were divided into 5 groups:control group (SO) n=10, SG group n=10, SADJB-SG groups n= 30, according to the position of the duodenal anastomosis was divided into SA10 group n=10, SA20 group n=10 and SA30 group n=10. Ora glucose tolerance test (OGTT) was measured on the first day (rats was 6 weeks old), preoperative day 3 and postoperative week 8. Hyperglycemic clamp was measured on postoperative week 8.Result SG and SADJB-SG both can effectively reduce the fasting blood glucose and insulin, as well as the area under the curve of OGTT-glucose and OGTT-insulin. Both of SG and SADJB-SG can increase the first phase insulin secretion and second phase insulin secretion, and increase the glucose disposal rate, but the insulin sensitivity index was no significantly different from the SO group.Conclusion SG and SADJB-SG both can effectively reduce the fasting blood glucose and insulin, as well as the area under the curve of OGTT-glucose and OGTT-insulin, and increase the first phase insulin secretion and second phase insulin secretionParty III Study of the mechanism on Single Anastomosis Duodenal Jejunal Bypass with Sleeve Gastrectomy improving obesity and T2DMObjective To explore the mechanism on Single Anastomosis Duodenal Jejunal Bypass with Sleeve Gastrectomy improving obesity and T2DM Materials and methods Fifty obesity T2DM rats (SD rats fed with high fat and high glucose diet and intraperitoneal injection streptozotocin) were divided into 5 groups:control group (SO) n=10, SG group n=10, SADJB-SG groups n= 30, according to the position of the duodenal anastomosis was divided into SA10 group n=10, SA20 group n=10 and SA30 group n=10. Total ghrelin (TG) and acylated ghrelin (AG) was measured on the first day (rats was 6 weeks old), preoperative day 3 and postoperative week 8. GLP-1 was measured on the preoperative day 3 and postoperative week 8, the time points were follows: fasting, gavage 30min,60min and 90min.Result Obesity rats had lower serum TG level, but AG was unchanged, AG/TG increased. SG and SADJB-SG can further reduce the level of serum TG, AG was till no change, resulting AG/TG further increased. SADJB-SG can increase the level of serum GLP-1, both fasting and gavage, especially the level at 30min after gavage. The SA30 group had the highest level of GLP-1 at all the time points.Conclusion SG and SADJB-SG can further reduce the level of serum TG, AG was till no change, resulting AG/TG further increased. SADJB-SG can increase the level of serum GLP-1, both fasting and gavage, especially the level at 30min after gavage. The SA30 group had the highest level of GLP-1 at all the time points. |
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