AIM To explore the effect of sleeve gastrectomy(SG) with jejuno-jejunal or jejuno-ileal loop on glycolipid metabolism in diabetic rats.METHODS Diabetic rats, which were induced by high-fat diet(HFD), nicotinamide and ...AIM To explore the effect of sleeve gastrectomy(SG) with jejuno-jejunal or jejuno-ileal loop on glycolipid metabolism in diabetic rats.METHODS Diabetic rats, which were induced by high-fat diet(HFD), nicotinamide and low-dose streptozotocin, underwent sham operations, SG, SG with jejuno-ileal loop(SG-JI) and SG with jejuno-jejunal loop(SG-JJ) followed by postoperative HFD. Then, at the time points of baseline and 2, 12 and 24 wk postoperatively, we determined and compared several variables, including the area under the curve for the results of oral glucose tolerance test(AUCOGTT), serum levels of triglyceride, cholesterol and ghrelin in fasting state, homeostasis model assessment of insulin resistance(HOMA-IR), body weight, calorie intake, glucagon-like peptide(GLP)-1 and insulin secretions after glucose gavage at dose of 1 g/kg.RESULTS At 2 wk postoperatively, rats that underwent SG, SGJJ and SG-JI, compared with sham-operated(SHAM)rats, demonstrated lower body weight, calorie intake and ghrelin(P < 0.05 vs SHAM), enhanced secretion of insulin and GLP-1 after glucose gavage(P < 0.05 vs SHAM), improved AUCOGTT, HOMA-IR, fasting serum triglyceride and cholesterol(AUCOGTT: 1616.9 ± 83.2, 837.4 ± 83.7, 874.9 ± 97.2 and 812.6 ± 81.9, P < 0.05 vs SHAM; HOMA-IR: 4.31 ± 0.54, 2.94 ± 0.22, 3.17 ± 0.37 and 3.41 ± 0.22, P < 0.05 vs SHAM; Triglyceride: 2.35 ± 0.17, 1.87 ± 0.23, 1.98 ± 0.30 and 2.04 ± 0.21 mmol/L, P < 0.05 vs SHAM; Cholesterol: 1.84 ± 0.21, 1.53 ± 0.20, 1.52 ± 0.20 and 1.46 ± 0.23 mmol/L). At 12 wk postoperatively, rats receiving SG-JJ and SG-JI had lower body weight, reduced levels of triglyceride and cholesterol and elevated level of GLP-1 compared to those receiving SG(P < 0.05 vs SG). At 24 wk after surgery, compared with SG, the advantage of SG-JJ and SG-JI for glucolipid metabolism was still evident(P < 0.05 vs SG). SG-JI had a better performance in lipid metabolism and GLP-1 secretion of rats than did SG-JJ.CONCLUSION SG combined with intestinal loop induces better glycolipid metabolism than simple SG, with the lipid metabolism being more improved with SG-JI compared to SG-JJ.展开更多
Jejuno-jejunal intussusception is a rare complication of feeding jejunostomy tube placement. A case of one year old child who underwent gastric pull-up for complicated tracheo-esophageal fistula had jejuno-jejunal int...Jejuno-jejunal intussusception is a rare complication of feeding jejunostomy tube placement. A case of one year old child who underwent gastric pull-up for complicated tracheo-esophageal fistula had jejuno-jejunal intussusception induced by Witzel's feeding jejunostomy tube;is discussed with review of literature.展开更多
Objective: This case report aimed to demonstrate a possible neuromuscular effect of Latarjet nerves transection or truncal vagotomy, in association with sleeve gastrectomy plus antrojejunostomy, in order to reproduce ...Objective: This case report aimed to demonstrate a possible neuromuscular effect of Latarjet nerves transection or truncal vagotomy, in association with sleeve gastrectomy plus antrojejunostomy, in order to reproduce a Roux-en-Y gastric bypass (RYGB) mechanistic principles, in patients with previous Sleeve Gastrectomy (SG) who had had weight regain, with or without concomitant gastroesophageal reflux disease (GERD). Background: Sleeve gastrectomy (SG) is one of the most frequently performed bariatric operations worldwide. Nevertheless, weight regain and gastroesophageal reflux disease (GERD) have been consistently demonstrated, in association with this technique, which may require a revisional procedure. RYGB is an option in such a situation but, implies in gastrointestinal exclusions, which represents a shortcoming of this revision. Surpassing this inconvenient would be of great value for the patients. Methods: We describe herein two cases of SG revision for weight regain and GERD, with a follow-up of one year. Gastroesophageal reflux disease was evaluated by validated questionnaire, upper endoscopy, seriography, high resolution manometry (HRM) and impedance pHmetry (I-pHmetry), in the pre and postoperative periods. A re-Sleeve Gastrectomy with antrojejunal anastomosis was done in both cases, after informed consents. The Latarjet nerves were transected in one case, due to a bleeding in the left gastric vessels and a truncal vagotomy was required in the other, to appropriately treat an associated hiatal hernia. Results: In the postoperative evaluation it was observed a pyloric spasm in both cases, during seriography and endoscopy, kept until the one-year follow-up. There was unidirectional contrast flow to the gastrointestinal anastomosis, filling the jejunal limb, in radiologic contrast study. No contrast passed through the pylorus. Nonetheless, the duodenum was kept endoscopically accessible. In the one-year evaluation, weight loss was adequate and GERD resolution was obtained in both cases, confirmed by endoscopic and functional esophageal assessment, together with symptoms questionnaire. Conclusion: The association of Latarjet nerves sectioning or truncal vagotomy with re-sleeve gastrectomy plus gastrointestinal anastomosis (antrojejunal), in a revision for a failed sleeve, can represent a technical approach, to reproduce RYGB results, without exclusions and with duodenum endoscopic accessibility maintenance. It maybe could be applied for primary surgeries. Additional studies are necessary to confirm this hypothesis.展开更多
目的:探讨袖状胃切除术联合Roux-en-Y空回肠旁路术对肥胖型2型糖尿病患者的治疗效果,为肥胖型2型糖尿病患者手术治疗方式的选择提供参考依据。方法:回顾性分析2009年1月至2014年5月我院接受手术治疗的体重指数(body mass index,BMI)>...目的:探讨袖状胃切除术联合Roux-en-Y空回肠旁路术对肥胖型2型糖尿病患者的治疗效果,为肥胖型2型糖尿病患者手术治疗方式的选择提供参考依据。方法:回顾性分析2009年1月至2014年5月我院接受手术治疗的体重指数(body mass index,BMI)>35 kg/m2的24例2型糖尿病患者的临床资料。比较术前、术后患者的BMI下降情况、糖尿病缓解率、空腹血糖和糖化血红蛋白下降情况,及术后营养和并发症发生情况。结果:所有患者均行开腹手术治疗,术后随访≥1年,术后出现肠梗阻3例,胃瘫2例,腹壁切口感染5例,腹泻3例,全组患者无死亡、无大出血、无吻合口瘘、狭窄及贫血、维生素缺乏等并发症发生。术后患者BMI均下降明显(P<0.05),糖尿病缓解率91.6%(21/24例,其中完全缓解20例,胰岛素注射改口服降糖1例,胰岛素注射剂量减半者1例),糖尿病合并症明显缓解。结论:袖状胃切除联合Roux-en-y空回肠旁路术治疗肥胖型2型糖尿病短期疗效确切,是值得临床推广的术式之一。展开更多
基金Supported by the National Natural Science Foundation of China,No.81471019(to Hu SY)No.81300286(to Liu SZ)+1 种基金and No.81370496(to Zhang GY)the Taishan Scholar Foundation(to Hu SY)
文摘AIM To explore the effect of sleeve gastrectomy(SG) with jejuno-jejunal or jejuno-ileal loop on glycolipid metabolism in diabetic rats.METHODS Diabetic rats, which were induced by high-fat diet(HFD), nicotinamide and low-dose streptozotocin, underwent sham operations, SG, SG with jejuno-ileal loop(SG-JI) and SG with jejuno-jejunal loop(SG-JJ) followed by postoperative HFD. Then, at the time points of baseline and 2, 12 and 24 wk postoperatively, we determined and compared several variables, including the area under the curve for the results of oral glucose tolerance test(AUCOGTT), serum levels of triglyceride, cholesterol and ghrelin in fasting state, homeostasis model assessment of insulin resistance(HOMA-IR), body weight, calorie intake, glucagon-like peptide(GLP)-1 and insulin secretions after glucose gavage at dose of 1 g/kg.RESULTS At 2 wk postoperatively, rats that underwent SG, SGJJ and SG-JI, compared with sham-operated(SHAM)rats, demonstrated lower body weight, calorie intake and ghrelin(P < 0.05 vs SHAM), enhanced secretion of insulin and GLP-1 after glucose gavage(P < 0.05 vs SHAM), improved AUCOGTT, HOMA-IR, fasting serum triglyceride and cholesterol(AUCOGTT: 1616.9 ± 83.2, 837.4 ± 83.7, 874.9 ± 97.2 and 812.6 ± 81.9, P < 0.05 vs SHAM; HOMA-IR: 4.31 ± 0.54, 2.94 ± 0.22, 3.17 ± 0.37 and 3.41 ± 0.22, P < 0.05 vs SHAM; Triglyceride: 2.35 ± 0.17, 1.87 ± 0.23, 1.98 ± 0.30 and 2.04 ± 0.21 mmol/L, P < 0.05 vs SHAM; Cholesterol: 1.84 ± 0.21, 1.53 ± 0.20, 1.52 ± 0.20 and 1.46 ± 0.23 mmol/L). At 12 wk postoperatively, rats receiving SG-JJ and SG-JI had lower body weight, reduced levels of triglyceride and cholesterol and elevated level of GLP-1 compared to those receiving SG(P < 0.05 vs SG). At 24 wk after surgery, compared with SG, the advantage of SG-JJ and SG-JI for glucolipid metabolism was still evident(P < 0.05 vs SG). SG-JI had a better performance in lipid metabolism and GLP-1 secretion of rats than did SG-JJ.CONCLUSION SG combined with intestinal loop induces better glycolipid metabolism than simple SG, with the lipid metabolism being more improved with SG-JI compared to SG-JJ.
文摘Jejuno-jejunal intussusception is a rare complication of feeding jejunostomy tube placement. A case of one year old child who underwent gastric pull-up for complicated tracheo-esophageal fistula had jejuno-jejunal intussusception induced by Witzel's feeding jejunostomy tube;is discussed with review of literature.
文摘Objective: This case report aimed to demonstrate a possible neuromuscular effect of Latarjet nerves transection or truncal vagotomy, in association with sleeve gastrectomy plus antrojejunostomy, in order to reproduce a Roux-en-Y gastric bypass (RYGB) mechanistic principles, in patients with previous Sleeve Gastrectomy (SG) who had had weight regain, with or without concomitant gastroesophageal reflux disease (GERD). Background: Sleeve gastrectomy (SG) is one of the most frequently performed bariatric operations worldwide. Nevertheless, weight regain and gastroesophageal reflux disease (GERD) have been consistently demonstrated, in association with this technique, which may require a revisional procedure. RYGB is an option in such a situation but, implies in gastrointestinal exclusions, which represents a shortcoming of this revision. Surpassing this inconvenient would be of great value for the patients. Methods: We describe herein two cases of SG revision for weight regain and GERD, with a follow-up of one year. Gastroesophageal reflux disease was evaluated by validated questionnaire, upper endoscopy, seriography, high resolution manometry (HRM) and impedance pHmetry (I-pHmetry), in the pre and postoperative periods. A re-Sleeve Gastrectomy with antrojejunal anastomosis was done in both cases, after informed consents. The Latarjet nerves were transected in one case, due to a bleeding in the left gastric vessels and a truncal vagotomy was required in the other, to appropriately treat an associated hiatal hernia. Results: In the postoperative evaluation it was observed a pyloric spasm in both cases, during seriography and endoscopy, kept until the one-year follow-up. There was unidirectional contrast flow to the gastrointestinal anastomosis, filling the jejunal limb, in radiologic contrast study. No contrast passed through the pylorus. Nonetheless, the duodenum was kept endoscopically accessible. In the one-year evaluation, weight loss was adequate and GERD resolution was obtained in both cases, confirmed by endoscopic and functional esophageal assessment, together with symptoms questionnaire. Conclusion: The association of Latarjet nerves sectioning or truncal vagotomy with re-sleeve gastrectomy plus gastrointestinal anastomosis (antrojejunal), in a revision for a failed sleeve, can represent a technical approach, to reproduce RYGB results, without exclusions and with duodenum endoscopic accessibility maintenance. It maybe could be applied for primary surgeries. Additional studies are necessary to confirm this hypothesis.
文摘目的:探讨袖状胃切除术联合Roux-en-Y空回肠旁路术对肥胖型2型糖尿病患者的治疗效果,为肥胖型2型糖尿病患者手术治疗方式的选择提供参考依据。方法:回顾性分析2009年1月至2014年5月我院接受手术治疗的体重指数(body mass index,BMI)>35 kg/m2的24例2型糖尿病患者的临床资料。比较术前、术后患者的BMI下降情况、糖尿病缓解率、空腹血糖和糖化血红蛋白下降情况,及术后营养和并发症发生情况。结果:所有患者均行开腹手术治疗,术后随访≥1年,术后出现肠梗阻3例,胃瘫2例,腹壁切口感染5例,腹泻3例,全组患者无死亡、无大出血、无吻合口瘘、狭窄及贫血、维生素缺乏等并发症发生。术后患者BMI均下降明显(P<0.05),糖尿病缓解率91.6%(21/24例,其中完全缓解20例,胰岛素注射改口服降糖1例,胰岛素注射剂量减半者1例),糖尿病合并症明显缓解。结论:袖状胃切除联合Roux-en-y空回肠旁路术治疗肥胖型2型糖尿病短期疗效确切,是值得临床推广的术式之一。
