The new concept of modern medical treatment of diabetes: from the past, the main focus was on lowering sugar, it has changed to the current overall goal of comprehensive prevention and treatment of cardiovascular and cerebrovascular disease risk factors, prevention of type 2 diabetes, prevention of damage to target organs such as heart, brain and kidney, and reduction of the incidence of cardiovascular and cerebrovascular disease or mortality. Therefore, avoiding mortality and disability, improving the quality of life of diabetic patients, and prolonging the life span of diabetic patients. This is the goal of diabetes treatment. However, only effective treatment can achieve such results. So, what treatment is effective treatment? The fact that surgical procedures can cure type 2 diabetes is continuously being recognized by clinically cured patients.
I. Surgical modalities.
1. “Y” type gastrointestinal short-circuit surgery
2. Modified simple gastrointestinal short-circuiting
3. Biliopancreatic open surgery or duodenal transposition
4. Tubular gastric gastrectomy
5. Adjustable gastric banding.
6. Ileal transposition
7. Ileal transposition combined with gastrointestinal diversion
II. Mechanism of surgical treatment of type 2 diabetes mellitus.
1, through surgery to remove part of the stomach or intestine, can reduce the intake and absorption of food, thereby reducing energy intake and glucose metabolic load;
2, through surgery, the patient’s weight reduction, can reduce the insulin resistance caused by the fat accumulation of simple obesity;
3. Through surgery, the secretion of hormones in the intestine-insulin axis can be changed, thus enhancing insulin secretion, reducing insulin resistance and improving glucose metabolism.
â‘ Hindguthypothesis: food stimulation induces an increase in synthesis and/or secretion of gut-derived endocrine hormones, such as glucagon-like peptide-1 (GLP-1), which regulates islet endocrine function through the gut-islet axis, increases insulin synthesis and/or release, and improves insulin sensitivity in peripheral tissues; L-cells secrete factors with hypoglycemic endoglycemia.
The foreguthypothesis is that nutrients avoid stimulation of the gastroduodenum and reduce the release of substances such as “insulin resistance factor” secreted by K cells.
Indications for surgery.
1. The patient’s age should not be older than 65 years
2. The duration of diabetes mellitus is less than 15 years.
3. The patient’s islet reserve function (C-peptide) is more than 1/2 of the lower limit of normal, and there is no serious mental disorder or intellectual disability. 4. 4.
4. Which patients cannot do gastric diversion surgery?
1.Patients with advanced diabetes mellitus and pancreatic islet failure;
2.Serious organic diseases that cannot tolerate the surgery;
3, gastrointestinal tract dysfunction, moderate to severe diabetic gastroparesis;
4.Patients with a history of diabetes mellitus greater than 15 years or age greater than 70 years, suffering from serious complications;
5, autoimmune diabetic patients are considered as appropriate