The curative effect of surgical treatment for obesity and type 2 diabetes mellitus has been internationally recognized.In mainland China,the number of the minimally invasive gastric volume reduction surgery has been increased from 110 cases in 2008 to 2000 cases in 2012.While some of the patients suffered from poor curative effects or severe postoperative complications due to lack of unified standard treatment guidelines.Authoritative statistical agencies and the Chinese clinical database has not been formed till now,therefore the specification and promotion of Chinese surgical treatment standards for obesity and type 2 diabetes mellitus is imperative.

Gastrectomy ; Gastric Bypass ; Humans

Obesity-induced insulin resistance and metabolic syndrome continue to pose an important public health challenge worldwide.Metabolic surgery was developed with the aim of weight reduction.In recent years,authors have witnessed great advancement in metabolic surgery,including the development of new and safe procedures or devices.During the last decade,improvements in glycemic control and decreases in cardiovascular events and mortality after surgery have been consistently reported.Therefore,there is an urgent need to identify the type of patients that may benefit the most from metabolic surgery,morbidly obese or not,and selection criteria must be reviewed and updated based on the current surgical outcomes.This article reviews the history of metabolic surgery and summarizes the new perceptions in obesity treatment.

With the rapid development of China's economy,obesity and diabetes have become a serious social problem.Metabolic surgery has grown mature abroad,while it started relatively late in China.There is obvious lack of operative indications,mode and procedure,preventions of complications,perioperative management and follow-up in the early time.To standardize nationwide surgical treatment of diabetes,to make the treatment of type 2 diabetes mellitus (T2DM) patients with the best way,to reduce the incidence of postoperative complications,the domestic famous experts assembled by the Branch of Obesity and Diabetes Surgeons Committee of the Chinese Medical Doctor Association composed the Surgical Treatment Guidance of Obesity and Type 2 Diabetes in China (2014).Metabolic surgery rapidly be popularized across the country.The number of surgery is rising year by year,especially making further standardization of operative indications and modes.Many academic meetings are conveyed to promote the discipline to develop,and provide the communication platform for metabolic surgeons.The future development of metabolic surgery will be accompanied by technological progress,equipment updates,operation excellence and continuous improvement.

With the rapid development of minimally invasive techniques,the emergence of three-dimensional (3D) laparoscope leading minimally invasive surgical accessPrecise Time.In the past 60 years,bariatric surgery provides a large number of clinical evidences to confirm:metabolic and bariatric surgery is lasting and effective for obesity combined with type 2 diabetes mellitus (T2DM),and it is also the best treatment method for T2DM.The author believes that 3D laparoscopic system can help beginners quickly master laparoscopic surgical techniques and shorten the learning curve to master the technical points.Compared with two-dimensional (2D) laparoscopic surgery,3D laparoscopic stereo vision can help experienced bariatric surgeons shorten operation time which is related to surgical procedures.The shorter surgical procedure in laparoscopic sleeve gastrectomy is hardly affecting the operation time.Because gastric bypass surgery is relatively complex,3D laparoscopic techniques which are fully utilized in gastric bypass surgery can effectively shorten the operation time.

In recent decades, human lifestyle has undergone tremendous changes with the development of society,obesity, type 2 diabetes mellitus and related metabolic diseases have been prevalent around the world.In addition to the traditional treatment including diet control, lifestyle modification and drug intervention, bariatric and metabolic disease surgeries have become the significant therapeutic means.In recent years, the international community has made some breakthroughs in the mechanisms of surgical treatment for obesity and metabolic disease, the mechanism that gastrointestinal surgery activates the body to increase energy expenditure and white adipose tissues convert to brown become the new hot spot.In western countries,bariatric surgery has already undergone semicentennial renewal and evolution.Currently, classical metabolic surgery methods basically reach a consensus worldwide, however, along with the changes of the surgery methods, patients who accept early surgical treatments of obesity and metabolic disease or who are not satisfied with the initial surgery can be further remedied through repairing operation.In addition, the rapid development of endoscopic technique provides a new idea for renewal of bariatric surgery.This review focuses on the latest international developments about the mechanisms of metabolic disease surgery and the innovation of operation methods.

ObjectiveTo study the feasibility,safety and efficacy of laparoscopic cyst excision and Roux-en-Y hepaticojejunostomy for adult congenital choledochal cyst.MethodA retrospective study was conducted on 7 adult patients with congenital choledochal cyst who received total laparoscopic cyst excision and Roux-en-y hepaticojejunostomy from May 2008 to February 2011 in the Department of General Surgery of Shengjing Hospital,China Medical University.ResultsAll the laparoscopic surgery was successful.The mean operation time was 210 minutes.The average intraoperative blood loss was 80 ml.All patients were out of bed within the first 24 h after surgery.The mean time to first flatus/bowel motion was 2.4 days.Except 1 patient who had small amount of bile leakage,all patients recovered smoothly without any major postoperative complications.The average hospital stay was 8.1 days.No patients suffered from abdominal pain,fever or jaundice during follow-up from 3 to 30 months.ConclusionTotal laparoscopic cyst excision and Roux-en-Y hepaticojejunostomy was a safe,efficacious,and minimally invasive procedure.

Objective To investigate the 5-year efficacy of laparoscopic sleeve gastrectomy for the treatment of morbid obesity.Methods The clinical data of 31 patients with severe morbid obesity and related complications who were admitted to the Shengjing Hospital of Chinese Medical University from January 2006 to December 2007 were retrospectively analyzed.The 31 patients received laparoscopic sleeve gastrectomy and were followed up for 5 years to observe the perioperative condition,incidence of long-term complications,application of hypoglycemic drug and insulin before and after operation,the body mass index (BMI) was detected 6 months,1,2,3,4,5 years after operation,and the decrease of excess weight loss (EWL) was analyzed.The remission rate of complications,incidence of complications and the patient satisfaction score were recorded.The count data were analyzed using the chi-square test or Fisher exact probability.Repeated measurement data were analyzed using the repeated measure ANOVA,a Greenhouse-Geisser adjustment was used to correct serial dependency.Results Twenty-five patients were followed up for 5 years postoperatively.Of the 25 patients,4 (16.0％) had gastroesophageal reflux disease,and were cured by medical treatment; 1 patient (4％) had anastomotic stenosis; the percentage of EWL of 2 patients (8.0％) was under 60％ ; 4 patients (16.0％) had occasional obdominal pain.The percentage of patients with diabetes mellitus was decreased from preoperative 9.7％ (3/31) to postoperative 4.0％ (1/25),with a significant difference (P ＜ 0.05).The percentage of patients with fatty liver was decreased from preoperative 93.5％ (29/31) to postoperative 32.0％(8/25),with significant difference (x2=19.10,P ＜ 0.05).The percentage of patients with hyperlipidemia was decreased from preoperative 77.4％ (24/31) to postoperative 12.0％ (3/25),with significant difference (x2 =35.51,P ＜ 0.05).The level of BMI was decreased from preoperative (38.8 ±4.2) kg/m2 to postoperative (28.5 ± 3.1) kg/m2,with significant difference (F =113.36,P ＜ 0.05).The percentage of EWL was increased from preoperative 42％ ± 11％ to postoperative 69％ ± 16％,with significant difference (F =41.71,P ＜0.05).There was no significant difference in the patient satisfaction score between each year within the 5 years (F =0.92,P ＞ 0.05).Conclusions Laparoscopic sleeve gastrectomy is effective in losing weight with few long-term complications.

Objective:To investigate the change of expression of AQP 2 in renal of obstructive jaundice rats , and the relationship between AQP 2 and the changing of Cr and BUN.Methods: Legated the common bile duct of rats to form the obstructive jaundice group.Scarified the rats on the 3th,5th,7th,10th,14th day,took blood samples and the kidney of the rats.Test direct bilirubin BUN and Cr in serum,the renal histopathological changes were observed by optical microscopy .The expression of AQP2 in renal of rats was tested by using radio immunological method.Results: Light microscopic examination of kidney showed that swelling epithelium arranged irregularly in 3rd day ,bleb in the 5th day.The expression of AQP2 in renal of rats with obstructive jaundice were greatly less than sham operation.Mesenchyma inflammatory cells infiltrate in 7th day.Local epithelial necrosis and lots of inflammatory cells infiltrate in the mesenchyma in 10th day and 14th day.The expression of AQP2 in renal collective tubule was decreased on the 5th day compared with sham operation ,and the decrease was more as time gone by.The renal function injury can be confirmed though the renal collective tubule change.Cr and BUN in serum began to increase on the 10th day and 14th day.Conclusion: Decrease of AQP2 is earlier than the increase of Cr and BUN ,and it can be the early sign of renal function injury.

Objective To investigate the changes of renal medulla aquaporin 2 expression and morphological changes of epithelia of collecting tube after bile duct recanalizaiton operation.Methods Thirty rats were divided into two groups randomly.Common bile duct ligation was performed on 20 experimental rats with silicon tubes 2 mm in extre-diameter,and sham operation on the other 10 rats.Seven days later,bile duct recanalizaiton was performed on obstructive jaundice group and sham operation on contrast group.Experimental rats were divided into two subgroups randomly.Half of them were killed immediately and the others would be killed 24 hours later.Serum of each rat was collected to detect hepatic function and renal function.Renal medulla was fixed for microscopic examination and was kept in the-80 ℃ refrigerator for aquaporin 2 expression measurement by Western blot technique.ResultsAll of the animals accomplished the experiment smoothly.Golden ascites were found in the rats of obstructive jaundice group.Twenty-four hours after recanalization,serum bilirubin levels decreased 〔(45.95?8.39)?mol/L〕,P