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Objective:To investigate the safety and efficacy of metabolic surgery in obese and type 2 diabetes patients with viral hepatitis cirrhosis.Methods:The data of 8 patients with viral hepatitis cirrhosis undergoing metabolic surgery at Department of General Surgery ,Beijing Tiantan Hospital, Capital Medical University from Aug 2012 to Dec 2021 were retrospectively analyzed.Results:Among the 8 patients, 2 underwent laparoscopic Roux-en-Y gastric bypass and 6 underwent laparoscopic sleeve gastrectomy. The Child-Pugh classification of all patients before operation was classified as Grade A. The operation process was successful with no complications such as ascites, bleeding , digestive tract and gastric leakage or obstruction during the perioperative period. There was no abnormal liver function and decompensation during the median 2.5 year's (3 month to 8 years) follow-up period. The weight loss after the operation was obvious, when 1 year after operation, percentage of excess weight loss (EWL%)>54.78% and the surgery was also conducive to the control of blood glucose in diabetes patients.Conclusion:Metabolic surgery is safe and feasible for obese and type 2 diabetes patients with viral hepatitis cirrhosis.
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Objective:To investigate the clinical effect of laparoscopic sleeve gastrectomy (LSG) in the treatment of obesity with non-alcoholic fatty liver disease (NAFLD).Methods:The clinical data of 115 obese patients with NAFLD who underwent LSG surgery at Beijing Tiantan Hospital were analyzed.Results:LSG was successful in a 115 patients, and the body weight and BMI decreased gradually, and were significantly lower than the preoperative level (all P<0.001). EWL% increased and was 73.1%±30.1% at 12 months after operation. The postoperative triglyceride level decreased and was significantly lower than the preoperative level (all P<0.05). Most patients were complicated with abnormal liver function before surgery, and ALT, AST and GGT levels decreased to the normal range 3 months after surgery (all P<0.05). Albumin level was significantly higher 3 months after operation than before operation ( P<0.001). At 12 months postoperatively, the severity grade of fatty liver on ultrasound was significantly lower than that before surgery ( P<0.001). Conclusion:Laparoscopic sleeve gastrectomy can significantly improve lipid metabolism index, liver function index and fatty liver index in NAFLD patients along with weight loss .
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Objective To investigate the effects of gastric bypass on glycometabolism and improvement of islet β cell function and insulin resistance in patients with type 2 diabetes. Methods Eight patients with type 2 diabetes combined with gastric carcinoma who treated with gastric bypass were studied prospectively. Fasting and postprandial plasma glucose levels, fasting and postprandial insulin C-peptide levels, and body mass index (BMI) were measured right before the surgery and at intervals of 1 week, 2 weeks, 1 month and 3 months after the surgery. Glycosylated hemoglobin (HbA1c) levels were measured before and 3 months after the surgery. The outcome of the diabetes after 3 months of the surgery was also monitored. Results Fasting and postprandial plasma glucose levels decreased (P ＜ 0.05) and fasting and postprandial insulin C-peptide levels increased (P ＜ 0.05) after the surgery. HbA1c levels also decreased (P ＜ 0.05) after 3 months of the surgery. There was no significant change of BMI at all intervals after the surgery(P＞ 0.05). All of the 8 patients reached the total effective standard and 6 patients reached the clinical remission standard after 3 months of the surgery. Conclusions It suggests that gastric bypass can significantly lower plasma glucose levels in type 2 diabetes, which does not depend on the loss of weight. The control of plasma glucose by gastric bypass may be due to the improvement of islet β cell function and increasing secretion of endogenous insulin.
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Objective To discuss the clinical features,diagnosis and operative treatment in Crohn disease(CD)characterized by acute abdomen.Method The clinical data of 26 CD cases testified by pathology after emergency operations from April 1997 to February 2009 were retrospectively analyzed.Results In 26 cases of acute abdomen,17 cases characterized by mechanical obstruction,6 cases characterized by peritonitis,3 cases characterized by hemorrhage of digestive tract.Eight cases(30.8%)were diagnosed before operation,and 13 cases(50.0%)were diagnosed during operation,totally 80.8%(21/26).All patients received surgical operations as following:resection and anastomosis in 21 eases,resection and fistulation in 4 cases,ileotransverso-stomy in 1 case.Two cases died after operation,and others discharged including 1 case received second operation within 5 days.Conclusion It is difficult to be diagnosed before operation when CD characterized by acute abdomen,and appropriate emergency operations are needed according to the particular cases.
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Objective To develop a method of adult porcine pancreatic islet isolation.Methods The tails of adult porcine pancreas were perfused through the pancreatic duct with 0.1% cold collagenase(type Ⅺ) and incubated at 38.5 ℃.The digested tissue was dispersed in 4 ℃ Hanks balanced salt solution(HBSS).The tissue suspensions were filtered through a 600 ?m mesh.The residual tissue was resuspended in cold HBSS,and put in the Ricordi’s chamber and shaken for 5 minutes,then filtered again.The isolated islets were divided into three groups: control group( n =14),Pefabloc(trypsin inhibitor, n =8) group and FOY(trypsin inhibitor, n =5) group.The collagenase solution of the Pefabloc and FOY group was supplemented with 1.0 mmol/L Pefabloc and FOY respectively. Results The islet yields of the Pefabloc group and FOY group 〔(11 848?3 530) islet/g pancreas and (14 496?3 693) islet/g pancreas〕 were significantly higher than that of the control group 〔(8 505?3 349) islet/g pancreas〕, P
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Objective To explore the method of isolation, identification and in vitro differentiation of islet stem cells in neonatal rat. Methods The whole pancreata of neonatal rats were digested with collagenase, then,under the (condition) of pH 7.4～7.6,the digested tissue fragments were cultured with serum and serum-free RPMI 1640 (( bFGF), EGF, N2).The whole formation process of new islet cell-like cell masses was examined.The insulin (release) test was used to detect islet function. The expression of nestin was tested by immunocytochemistry. Results The nestin positive cells can be found within 36 h of culture of the digested pancreatic fragments.After addition of bFGF,ECF,N2,nestin positive cells proliferated fast and formed new islets-like cell masses after 18～24 d, and (insulin)ssion could be confirmed. Conclusions The nestin positive cells of pancreatic cells possess the character of islet stem cells, and can form islet like cell masses through culture in vitro.
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Objective To explore the isolation, culture of nestin positive cells of the pancreas in newborn rats. Methods The whole pancreas of neonatal rats were digested with collagenase, followed by incubation under pH 7. 6 serum RPMI 1640 for 24 - 36 h and then under pH 7. 4 serum free RPMI 1640 (bFGF.EGF 20 ng/ml.1% N2) for 18-24 d. The expression of insulin.glucagon and nestin were detected by immunofluorescence technique. Nestin.CK19 were detected by RT-PCR. Resides Cells attached to the surface of plates after 24 h incubation under pH 7. 6 condition, and islet-like masses were obtained after 18 -24 d incubation. A monolayer of cells grew out after 24 h of passage of islet-like masses. Nestin positive cells was detected after 24 - 36 h incubation, with no expression of insulin and glucagon. Positive cells of insulin and glucagon were detected in islet-like masses after 24 h passage. Nestin positive cells were detected by RT-PCR in islet-like masses after 24 h passage, but no CK19. Conclusion Insulin and glucagon were expressed in islet-like masses after passage. Nestin positive cells in the pancreas of neonatal rats possessed character of islet stem cells.
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Objective:To study the safety and effect of enteral nutrition in preoperative bowel preparation and postoperative early enteral nutritional support for patients with colorectal cancer.Methods:42 patients with colorectal cancer were randomized into 2 groups.21 patients in the experimental group(enteral nutrition group) were applied with Nutrison Fibre as a kind of liquid diet in preoperative bowel preparation and postoperative early(in 12~24 hours) enteral nutritional support.21 patients in the control group(traditional therapy group) made the bowel preparation by the traditional method of semiliquid-liquid-fasting with infusion and managed with ordinary process after operation.The times of intestinal lavage the evening before operation,the satisfaction of colon cleaning,recovery time of passing flatus,occurrence of ill reaction and complication were observed.Parameters including body weight,hemoglobin(Hb),lymphocyte count(LY),plasma total protein(TP),serum albumin(ALB),prealbumin(PA) were measured and compared before bowel preparation(3th day before operation),before operation and on the 8th day after operation.Results:There were no statistical difference in the two groups about the satisfaction of colon cleaning.In the experimental group,the time of intestinal lavage was fewer(P(0.05).) But in the control group,Hb,LY,TP,ALB and PA were all significantly lower(P