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Objective To explore the clinical efficacy of laparoscopic improved ileal bypass (LIB)for treatment of type 2 diabetes mellitus(T2DM).Methods The clinical data of 52 patients who received LIB for T2DM at the Center Hospital Xianyang City,Southern Medical University,from May.2012 to Jul.2015 were retrospectively analyzed.On the basis of their body mass index (BMI),all cases were divided into two groups:group A (16 cases,BMI≥28 kg/m2) and group B(36 cases,BMI ＜28 kg/m2).LIB surgery were complete by laparoscopic ultrasound knife and the cutting anastomat etc.Before and during one year after surgery fasting blood glucose(FBG),fasting c-peptide,glycosylated hemoglobin (HbA1c) and BMI were detected to evaluate the outcome of T2DM.Count data and comparison of rates were analyzed by chi-square test.Measurement data with normal distribution were presented as ±s and analyzed by the t test.Repeated measurement data were analyzed by the repeated measuresanalysis of variance.Results All the 52 patients underwent successful LIB without perioperative death during the follow-up of 12 months.There were significant differences in FBG and HbA1c at admission and 12 months after surgery:group A (t=4.223,3.602,P＜0.05);group B (t=4.356,5.613,P＜0.05).With reference to the literature[1] curative effect evaluation standard,13 patients had complete remission,2 patients had partial remission and 1 patient had non-remission in group A,accounting for 81.25％,12.5％,and 6.25％ respectively.For 36 patients in group B,32 patients had complete remission,3 patients had partial remission and 1 patient had non-remission,accounting for 88.9％,8.3％,and 2.8％ respectively.Total treatment effectiveness was 96.2％ (50/52).No significant differences was found between group A and group B at 12 months after surgery (X2=0.053,P＞0.05).BMI at admission and 12 months after surgery had no significant differences in group A (t=1.581,P＞0.05),nor group B(t=2.124,P＞0.05).Conclusions LIB for T2DM improved the glucose metabolism significantly,with unconspicuous influence for BMI and was indications for the non-obese T2DM.Due to the poor weight loss,LIB choose carefully in obese patients with T2DM.The therapy has small trauma,fewer complications,simple operation skills and facilitated clinical promotion.
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Objective To explore the operative cooperation of the intra-extra cranial bypass operation of the intracranial giant aneurysms. Methods A retrospective analysis of 7 patients who had intracranial giant aneurysm and received the intra-extra cranial bypass operation from October 2014 to June 2016. All preoperative and intraoperative nursing points of operative cooperation were analyzed. Results The post-operative digital subtraction angiographies of 7 patients without any perioperative nursing complications showed enough flow in the bypass arteries. Conclusions Operative multi-incision managing, positive temperature intervening, special instruments using and thrombosis preventing play very important roles in the nursing points of the successful operative cooperation.
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Objective Through compare the clinical data of two kinds of coronary bypass operation under Extacorpeal circulation and Non extracorpoeal circulation in patients over 70 years old with triple-vessel disease, and to provide the clinicalexperience. Methods Choose the patients hospitalized from Department of thoracic sur-gery 115 cases who had had coronary arterybypass grafting surgery from January 2014 to June 2017.there were 51 cases accepted Extracorporeal circulation surgery,Another 64 cases accepted Non-extracorpoeal circulation sur-gery.And make a comparative study of the clinical data of two kinds of coronary bypass operation. Results Com-pared with the Extacorpeal circulation group,the operation time,bypass vessel numb,the Thoracic Drainage were no statistic difference in Non-extracorpoealcirculation(P>0.05),The amount of transfused blood;Mechanical ven-tilation time,Hospitalized time in ICU;Postoperative complications;Total hospitalization time were Significantly lower than Extacorpeal circulation group,the difference was statistically significant(P < 0.05). Conclusions As the development of technology and the maturity of the operator′s experience,Off-pump coronary artery bypass graft-ing is safe and effective in elderly patients,which could be further promoted in clinical practice.
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It has been confirmed clearly that gastric bypass operation could be used for tbe treatment of type 2 diabetes mellitus.However,the curative mechanism underlying this therapy remain unclear up to now.Referencing the curative mechanisms research progress from domestic and abroad,the possible mechanism is considered as the secretion of gastrointestinal hormones can be changed after gastric by~ss operation,which has altered the normal anatomy structure of the gastrointestinal,and so as to the situation of type 2 diabetes mellitus can be controlled.This review will summarize recent papers related to mechanism research about the gastric bypass operatiou for the treatment of type 2 diabetes mellitus.
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There were 3,129 consecutive patients who underwent CABG by only one operator at Kishiwada Tokushukai Hospital between January 1991 and December 2010. These patients included 236 patients requiring chronic renal hemodialysis at the time of operation. They consisted of 181 men and 55 women, with an average age of 64.1±9.7 years. The mean duration of hemodialysis was 10.1±20.4 years. Diabetic nephropathy (133 cases, 56.4%) was the most common disease leading to required for hemodialysis. The operative mortality and the hospital mortality were 3.4% and 6.4% respectively. The 1-year survival rate, the 3-year survival rate, the 5 year survival rate and the 10-year survival rate were 72.4%, 48.3%, 32.4% and 14.3%. Multivariate logistic analysis revealed that only peripheral artery disease (PAD) was a significant risk factor for mortality (<i>p</i><0.05). The infectious diseases were the most common cause of long term death (24.1%). The mortality rates of CABG in patients with dialysis-dependent renal failure are still higher than those for non-hemodialysis patients. Our data suggest that PAD is a great risk factor for mortality following CABG in hemodialysis patients.
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Objective To study the mechanism of gastric bypass operation on treatment of type 2 diabetes mellitus,recognize the etiology and pathogenesy of the disease and frame therapy strategy for type 2 diabetes mellitus.Methods The literatures about gastric bypass operation on treatment of type 2 diabetes mellitus,including clinical cases reports and evidence-based studies were reviewed.Results Gastrointestinal bypass operation was regarded as an effective treatment for type 2 diabetes mellitus.There were three hypotheses of therapy mechanism: early delivery of nutrients to the distal intestine,exclusion of the proximal intestine and incretin/anti-incretin.Conclusion Gastrointestinal bypass operation is now considering as an effective treatment,there is still a lack of basic experimental studies to clarify the mechanism.
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Objective To observe the curative effect on non-obese type 2 diabetes and the effect on change of glucagon-like peptide-1 (GLP-1) of gastric bypass operation. Methods Thirty-two cases of gastric ulcer with non-obese type 2 diabetes were suffered gastric bypass operation. Plasma glucose concentrations, insulin and GLP-1 were measured respectively in fasting and postprandial conditions before operation and in week 1, 2, 3 and month 1, 3, 6 after gastric bypass operation, and the body mass index (BMI), homeostasis model assessment ? cell function index (HBCI) and glycosylated hemoglobin (HbA1c, the index was detected only before operation and in month 3, 6 after operation) were also measured. The turnover of the diabetes condition in the 6th month after surgery was observed. Results Compared with the levels before operation, the fasting and postprandial plasma glucose levels were descending (P0.05). The diabetes control rate was 78.1%(25/32) overall six months after operation. Level of GLP-1 was negatively correlated with level of plasma glucose (P
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Arterial stenotic and occlusive disorders of low limb are commonly the most important factors associated with the prognosis of diabetic foot.The effect of traditional bypass operation is unpredictable for lack of runoff artery.On the other hand,the contributions of special interventional devices and techniques targeted at infrapopliteal artery show unique therapeutic outcomes of interventional management;together with furthermore stem cell thansplantation would present a promising future for the treatment of diabetic foot.
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0.05);one week after surgery,the fasting blood glucose level showed a sustained and steady downward trend(P0.05).Conclusions Gastric bypass operation has a good therapeutic effect on type 2 diabetes in the non-obese patients,and this therapeutic effect is not dependent on loss of body weight.