Department of Human Pathology, University of Messina, Via C. Valeria, 98100 Messina, Italy.
Am J Surg. 2012 Aug;204(2):180-6. doi: 10.1016/j.amjsurg.2011.09.025. Epub 2012 Apr 4.
The exact mechanism for the dramatic effect of surgical procedures for obesity on type 2 diabetes remains unknown.
Five diabetic morbidly obese patients and 5 nondiabetic morbidly obese patients undergoing biliopancreatic diversion were compared retrospectively. A 75-g trans-gastrostomy glucose tolerance test was administered on the fifth day postoperatively and a standard 75-g oral glucose tolerance test was performed on the seventh day postoperatively, with blood sampling for measuring plasma glucose and insulin levels at 0, 30, 60, 90, 120, and 180 minutes.
All 5 diabetic patients were shown, at the same time, still to have diabetes or an impaired glucose tolerance test when tested through the biliopancreatic limb but patients were normal when tested through the new alimentary channel. No significant difference was seen in the nondiabetic patients.
Biliopancreatic diversion can completely normalize the glycemic cycle in type 2 diabetes patients in the week after the intervention, even before any significant weight loss has occurred. The surgical procedure itself, designed to exclude most of the stomach, duodenum, and part of the jejunum, directly affects carbohydrate homeostasis.
手术治疗肥胖型 2 型糖尿病的显著效果的确切机制尚不清楚。
回顾性比较了 5 例糖尿病肥胖患者和 5 例非糖尿病肥胖患者接受胆胰分流术的情况。术后第 5 天进行 75g 经胃葡萄糖耐量试验，术后第 7 天进行标准 75g 口服葡萄糖耐量试验，在 0、30、60、90、120 和 180 分钟时采集血样测量血糖和胰岛素水平。
5 例糖尿病患者在通过胆胰分流支检查时仍表现为糖尿病或糖耐量受损，但在新的营养通道检查时正常。非糖尿病患者无显著差异。
胆胰分流术可在术后一周内使 2 型糖尿病患者的血糖周期完全正常化，甚至在体重明显减轻之前。该手术旨在排除大部分胃、十二指肠和部分空肠，其本身直接影响碳水化合物的动态平衡。
