Metabolic surgery for obesity and type 2 diabetes mellitus has been received more and more attention in the world.After the development for more than 10 years,metabolic surgery has been widely carried out in China.With the development and progress of the new field of surgery,many related problems have emerged.Besides absorbing foreign experiences,our own practical experience should be also gradually formed according to the patients,condition and the situation of the development of the discipline in China.Therefore,related questions were explored in this article,in order to promote the healthy development of metabolic surgery in China.

Objective To discuss the effect of Billroth Ⅱ gastrectomy on glucose metabolism in patients with gastric cancer complicated with type 2 diabetes mellitus(T2 DM).Methods A retrospective study on the serum level of glucose in 7 patients with gastric cancer complicated with T2 DM undergone Billroth Ⅱ gastrectomy.The therapeutic regime for T2DM after the operation was also analyzed.Results Billroth Ⅱ gastrectomy was completed in all of the 7 patients by open surgery(3) or laparoscopy(4).No serious intra- and post-operative complications occurred in the series.The preoperative level of fasting plasma glucose(FPG) was between 6.6 and 9.0 mmol/L(mean 8.1 mmol/L) and glycosylated hemoglobin concentrations(HbA1c) between 6.8% and 9.5%(mean 7.8%).While 1 to 8 months after the surgery,the FPG decreased to 4.8-7.9 mmol/L(mean 6.4 mmol/L) and HbA1c 5.5% to 7.2%(mean 6.3%).According to the criteria from ADA,4 patients were cured and 3 were improved.Conclusion Billroth Ⅱ gastrectomy is effective for type 2 diabetes mellitus in patients with gastric cancer.

To evaluate the effects and safety of laparoscopic vertical banding gastroplasty (LVBG) in morbid obese subjects. The clinical data related to the metabolism of glucose, lipids and obesity in 26 obese Chinese patients with LVBG one year before and after the surgery were analyzed. The results showed that 1 year after LVBG, there was a reduction of 22.98?14.27kg in body weight, 9.31?5.13kg/m 2 in BMI, and a reduction of 47.19%?31.17% of body over-weight (EWL%) in these patients. BMI, waist, waist hip ratio, systolic blood pressure, fasting insulin, insulin resistance based on HOMA, triglyceride, cholesterol/HDL, ALT and blood creatine were decreased with reduction of body weight and BMI after LVBG. Changes in BMI and EWL% were significantly correlated with those of fasting insulin and insulin resistance. It is suggested that LVBG is effective and safe for reducing body weight and improving metabolism in the markedly obese patients.

Objective To investigate the effect of laparoscopic vertical banding gastroplasty (LVBG) on hepatic steatosis and metabolic abnormalities in morbidly obese patients one year after surgery.Methods A total of 11 morbidly obese patients with CT diagnosis of liver steatosis were studied to compare the following data before and one year after LVBG,including weight,body mass index(BMI),waist circumference,fasting plasma glucose(FPG),fasting insulin(FINS),insulin resistance index (HOMA IR), total cholesterol(TC),triglyceride(TG) and liver enzymes.Results With the loss of weight,BMI,waist circumference,FINS,HOMA IR and TG were declined,while liver CT values increased significantly after LVBG.The change of waist circumference was correlated with the change of FINS and that of HOMA IR significantly (P

Objective To know the cognition of residents of middle or small cities of China on adverse effects of indoor air pollution on human health.Methods 208 pupils of grade 2 to 4 were randomly selected in 2 primary schools in Taian city,and their parents were asked to fill in the questionnaires in May,2008.Results 72% of the total investigated families moved into their new houses within 3 months after the interior decoration was finished,and only 2% of the investigated families monitored the pollutants concentration after the decoration was finished.Most families hadn't the correct concepts on decoration pollution.52.88% of the investigated families considered that the newly decorated house should be safe if the green materials were used in the decoration.47.12% considered it was safe if no abnormal odor.39.42% said that indoor pollution could be eliminated by air refresher.55.76% to 62.5% of the investigated families hadn't the knowledge that furniture and fibrous materials may cause the indoor air pollution.As for the harm of decoration pollution,most families(above 50%) knew,but a few,such as cancer,leukemia and respiratory diseases.63.46% of the families did not really know China's policies and regulations on interior environment inspection.Conclusion In our country,it is very important for the prevention and control of the air pollution related diseases that the whole society should pay more attention to indoor air pollution and human health.

0 8*!cm) found by ultrasound. As a result tentative diagnosis of Mirizzi's syndrome was established in 54 cases accounting for 0 56% of all LC patients.Results Laparoscopic procedure was successful in 46 out of 50 type Ⅰ cases. Four cases suffering from iatrogenic bile duct injury received primary repairment under laparoscopy. Fistulae repairment was successful laparoscopically in 3 out of 4 cases of type Ⅱ Mirizzi syndrome.Conclusion Type Ⅰ and type Ⅱ Mirizzi syndromes can be safely and successfully managed under laparoscopy in the hand of careful and skilled operators.

Objective To evaluate the efficacy of laparoscopic Roux-en-Y gastric bypass(LRYGB)in the treatment of morbid obesity complicated with type 2 diabetes mellitus,and to discuss the mechanism of LRYGB in the treatment of type 2 diabetes mellitus.Methods The clinical data of 30 type 2 diabetes mellitus patients with body mass index(BMI)≥35.00 who had undergone LRYGB from January 2007 to July 2007 in Cleveland Clinic were prospectively analyzed.The pre-and postoperative clinical parameters wcl"e analyzed by t test.Results The BMI,fasting plasma glucose and glycosylated hemoglobin were significantly decreased 6 months after the operation(t=27.399,23.025.15.593,P＜0.05).The cure rate at the end ofthe second month was 70%(21/30),and it was increased to 90%at the end of sixth month(27/30).The condition of the remaining 3 patients were improved.At the end of the second and sixth month',ffter operation,the BMIs of the patients who were cured by LRYGB were decreased by 27.89%±5.51%and 45.73%±2.82%.and the BMIs of the patients whose condition was improved were decreased by 35.65%±1.97%and 58.00%±3.05%(t=5.755,7.081,P＜0.05).Conclusions LRYGB is effective in the treatment of morbid obesity complicated with type 2 diabetes mellitus.The curability of morbid obesity increases as the BMI decreases.

Objective To evaluate the clinical effect of tension-free mesh-plug repair in inguinal strangulated hernia. MethodsUsing the mesh-plug materials (Perfix-Plug) of Bard surgical product company, we performed operation on 19 patients suffering from strangulated indirect inguinal hernia. In these cases,14 patients were older than 60,17 patients had other severe diseases,and 5 cases had small intestine necrosis. ResultsThere was no postoperative mortality. The only complication was scrotal haematoma which occurred in one patient. All the patients retrieved motility two days after operation except those who had intestinal necrosis and underwent intestinal anastomosis. The length of hospital stay was 2 to 4 days or 6 to 7 days respectively in patients without or with intestinal necrosis. The follow-up period ranged from 3 to 16 months, and no recurrence was observed. ConclusionTension-free mesh-plug repair has the advantages of safety, minimal invasion and rapid recovery. Meanwhile, this method can be applied to those with intestinal necrosis with satisfactory results.

Objective To evaluate laparoscopy for insertion of peritoneal catheters in continuous ambulatory peritoneal dialysis (CAPD) patients. Methods Twenty patients of end-stage renal disease.During laparoscopic surgery,the peritoneal catheter was advanced into the abdomen by inducing thread.Results All procedures were completed by laparoscopy successfully. There was no intraoperative complication or surgical mortality. Conclusion Laparoscopy is feasible, safe, and effective for peritoneal catheters placement.

Objective To compare the short-term efficacies of laparoscopic adjustable gastric banding (LAGB) and laparoscopic sleeve gastrectomy (LSG) in the treatment of obesity and type 2 diabetes mellitus,and to investigate the relationship between the body weight loss and the decrease of glucose of the 2 treatment methods.Methods The clinical data of 40 patients with obesity combined with type 2 diabetes mellitus who were admitted to the Changhai Hospital of the Second Military Medical University from January 2010 to December 2011 were retrospectively analyzed.There were 14 patients treated by LAGB (LAGB group) and 26 by LSG (LSG group).The body weight loss and the decrease of glucose at postoperative year 1 of the 2 groups were compared.The differences in the body weight and glucose before and after operation within groups were compared using the paired t test,and the differences in the body weight and glucose between the 2 groups were compared using the multiple analysis of variance.The correlation between the body weight loss and the decrease of glucose was analyzed using the linear regression analysis.Results Laparoscopic surgery was successfully done without conversion to open surgery or intraoperative complications.The operation time and volume of blood loss were (69 ± 16)minutes and (31 ± 14)mL in the LAGB group,(120 ± 15) minutes and (148 ± 48) mL in the LSG group.Complications including postoperative malnutrition,electrolyte disturbance,delayed gastric emptying,bleeding,anastomotic leakage did not occurr in the 2 groups.Two patients were complicated with abdominal incision fat liquefaction,and were cured by symptomatic treatment.(1) The body weight,body mass index (BMI) and waistline had a decrease trend.The body weight,BMI and waistline in the LAGB group were decreased from (117 ± 28)kg,(40 ± 8)kg/m2 and (118 ± 15) cm before operation to (94 ± 28) kg,(33 ± 8) kg/m2 and (92 ± 15) cm at postoperative week 48.The body weight,BMI and waistline in the LSG group were decreased from (119 ± 25)kg,(42 ± 6)kg/m2 and (123 ± 14)cm before operation to (74± 16)kg,(26± 4)kg/m2 and (86 ± 13)cm at postoperative week 48.The EWL had an increase trend in the 2 groups.The EWL in the LAGB group was increased from 7％ ± 2％ at postoperative week 1 to 53％± 24％ at postoperative week 48,and the EWL in the LSG group was increased from 11％ ± 4％ at postoperative week 1 to 90％ ± 20％ at postoperative week 48.There were significant differences in the changes of body weight,BMI,waistline and EWL between the 2 groups (F =60.660,74.490,57.650,90.020,P ＜ 0.05).(2) The levels of glycosylated hemoglobin,fasting glucose,fasting insulin,HOMA-IR,triglyceride,total cholesterol,low-density lipoprotein and high density lipoprotein in the LAGB group were decreased from 8.1％± 0.8％,(8.4±0.6)mmol/L,(21±8)μmol/L,7.9 ±2.9,(1.68±0.50)mmol/L,(6.0±1.1)mmol/L (4.1 ± 0.8) mmol/L,(1.09 ±0.15)mmol/L to 6.4％ ±0.8％,(6.3 ±0.3) mmol/L,(10 ± 3) μmol/L,2.7 ±0.9,(1.04 ± 0.09) mmol/L,(4.3 ± 0.8) mmol/L,(2.3 ± 0.4) mmol/L,(1.22 ± 0.09) mmol/L at postoperative week 48 ; the levels of glycosylated hemoglobin,fasting glucose,fasting insulin,HOMA-IR,triglyceride,total cholesterol,low-density lipoprotein and high density lipoprotein in the LSG group were changed from 7.9％ ± 1.0％,(9.0±1.0)mmol/L,(21 ±9) μ mol/L,8.5 ±3.5,(2.09 ± 0.70) mmol/L,(6.0 ± 1.2)mmol/L,(3.9 ± 1.1) mmol/L,(1.06 ± 0.21) mmol/L before operation to 5.1％ ± 0.8％,(5.2 ± 0.4) mmol/L,(4 ± 1)μmol/L,0.9±0.2,(1.22±0.17)mmol/L,(4.2±0.8)mmol/L,(2.3 ±0.6)mmol/L,(1.30±0.13)mmol/L at postoperative week 48.There was a decrease trend of the glycosylated hemoglobin,fasting glucose,fasting insulin,HOMA-IR,trigluceride,total cholesterol and low density lipoprotein and a increase trend of the high density lipoprotein in the 2 groups.There were significant differences in the levels of glycosylated hemoglobin,fasting glucose,fasting insulin,HOMA-IR,triglyceride,total cholesterol,low-density lipoprotein and high density lipoprotein between the 2 groups (F =57.650,74.270,36.750,42.960,10.870,30.650,32.560,11.490,P ＜0.05).The levels of glucose of the LAGB group at postoperative month 1 and 3 were influenced by BMI (b =0.543,0.753,P ＜ 0.05),while the levels of glucose of the LAGB group did not be influenced by BMI at postoperative month 6 and year 1 (b =0.130,0.222,P ＞0.05).The levels of glucose of the LSG group did not be influenced by BMI at postoperative month 1,3,6 and year 1 (b =0.185,0.035,0.212,0.126,P ＞0.05).Conclusions The efficacy of LSG is superior to LAGB for the treatment of obesity combined with type 2 diabetes mellitus.The efficacy of LAGB is correlated with the change of body weight,while the efficacy of LSG does not correlated with the change of body weight.