大鼠十二指肠空肠旷置术的实验研究

Experiment Research on Duodenum-jejunal Bypass Surgery to Type 2 Diabetes Mellitus Rats

目的探讨大鼠十二指肠空肠旷置术的安全性及效果,明确其对2型糖尿病(type2 diabetes mellitus,T2DM)的治疗意义。方法取40只8周SD大鼠,随机分为糖尿病组(T组,n=20)和普通组(N组,n=20),均予高脂饮食。T2DM大鼠模型建立后,各组再分为两组:糖尿病手术组(To组)和糖尿病对照组(Tc组),正常手术组(No组)和正常对照组(Nc组),分别行DJB手术和假手术对照,每组10只。术后观察和记录各组存活率,术后8周手术探查大鼠腹腔观察其吻合情况。分别于术前、术后1、2、4、8周检测并比较各组大鼠空腹血糖和胰岛素水平。结果四组所有40只大鼠均施行手术,术后8周时To组存活率为80%,No组存活率为80%。术后8周处死大鼠并手术探查,见吻合口均连接紧密,无渗漏、出血,吻合口未见梗阻堵塞。To组血糖从术前的(22.71±5.26)mmol/L下降到术后8周的(4.05±2.39)mmol/L(P<0.05),且接近No组手术前后的血糖值。胰岛素从术前的(11.61±0.51)mU/L下降到(6.35±3.38)mU/L(P<0.05),且与术前No组的胰岛素值相近。与Tc组比较,To组术后各时点血糖均有降低,但在术后2、4和8周时血糖下降有统计学意义(P<0.05);To组术后各时点胰岛素较Tc组均有降低,差异均具有统计学意义(P<0.05)。结论 DJB手术肠肠吻合简便易操作,吻合口可形成严密瘢痕愈合,安全易行。术后可有效降低T2DM大鼠血糖,改善血中胰岛素水平。

Objective To investigate the stability and security of duodenum-jejunal bypass surgery （DJB） in the rats and to identify the therapeutic value to type 2 diabetes mellitus （T2DM）. Methods Forty eight-week SD rats were randomly divided into four groups： T2DM- operation group （To group） and T2DM-con- trol group （To group）, normal-operation group （No group） and normal-control group （NC group）. The DJB surgery was performed to To and No groups, and the sham control group to Tc and Nc groups. The survival rate was recorded, and surgical exploration was carried out to confirm the anastomotic stoma 8 weeks after the sur- gery. The fasting blood glucose and insulin were measured respectively before the operation and 1-, 2-, 4- and 8 weeks after the operation in all rats. Results All surgery was successfully completed in 40 rats. The sur- vival rate was 80% in both To and No group. The anastomotic stoma was achieved compact connection without leakage, bleeding, fistula and obstruction during the 8-week postoperative exploration. In To group, the fasting blood glucose was decreased from 22.71 ± 5.26 mmol/L of pre-operation to 4.05 ± 2.39 mmol/L of 8-week af- ter DJB surgery （P 〈 0.05 ）, and the insulin level was decreased too from 11.61 ± 0.51mU/L of pre-operation to 6.35 ± 3.38mU/L of 8-week after surgery （P 〈 0.05 ）, and both values at 8-week after surgery were closed to the homologue preoperative values. Compared to Tc group, both the value of the fasting blood glucose and insu- lin was obviously lower in To group, there was statistic difference in blood glucose at 2-, 4- and 8 weeks after the operation （ P 〈 0.05 ） and in insulin at 1 -, 2-, 4- and 8 weeks after the operation （ P 〈 0.05 ）. Conclu- sions DJB surgery is a safe and simple procedure with exactitude and reliable bowel intestinal anastomosis and without fistula or obstruction. It can decrease the fasting blood glucose and improve the blood insulin for T2DM SD rats.