Ulcerative jejunoileitis is an uncommon clinical syndrome consisting of abdominal pain,weight loss associated with diarrhea,and multiple inflammatory ulcerations and strictures of the small bowel.Ulcerative jejunoilei...Ulcerative jejunoileitis is an uncommon clinical syndrome consisting of abdominal pain,weight loss associated with diarrhea,and multiple inflammatory ulcerations and strictures of the small bowel.Ulcerative jejunoileitis can complicate established celiac disease or develop in patients de novo.Increased levels of tumor necrosis factor-alpha(TNF-α) in the small intestine of patients with untreated celiac disease are associated with a role in the immune pathogenesis of this disorder.No specific therapy has been shown to change the course of ulcerative jejunoileitis.We report a case of severe ulcerative jejunoileitis previously unresponsive to traditional therapies,including high dose corticosteroids and cyclosporine.The patient had a dramatic resolution of symptoms and a complete normalization of endoscopic findings after anti-TNF-α monoclonal antibody,infliximab(Remicade).展开更多
BACKGROUND At present,the existing internal medicine drug treatment can alleviate the high glucose toxicity of patients to a certain extent,to explore the efficacy of laparoscopic jejunoileal side to side anastomosis ...BACKGROUND At present,the existing internal medicine drug treatment can alleviate the high glucose toxicity of patients to a certain extent,to explore the efficacy of laparoscopic jejunoileal side to side anastomosis in the treatment of type 2 diabetes,the report is as follows.AIM To investigate the effect of jejunoileal side-to-side anastomosis on metabolic parameters in patients with type 2 diabetes mellitus(T2DM).METHODS We retrospectively analyzed the clinical data of 78 patients with T2DM who were treated via jejunoileal lateral anastomosis.Metabolic indicators were collected preoperatively,as well as at 3 and 6 months postoperative.The metabolic indicators analyzed included body mass index(BMI),systolic blood pressure(SBP),diastolic blood pressure(DBP),fasting blood glucose(FBG),2-hour blood glucose(PBG),glycated hemoglobin(HbA1c),fasting C-peptide,2-hour C-peptide(PCP),fasting insulin(Fins),2-hour insulin(Pins),insulin resistance index(HOMA-IR),βCellular function index(HOMA-β),alanine aminotransferase,aspartate aminotransferase,serum total cholesterol(TC),low-density lipoprotein cholesterol(L DL-C),triglycerides(TG),high-density lipoprotein,and uric acid(UA)levels.RESULTS SBP,DBP,PBG,HbA1c,LDL-C,and TG were all significantly lower 3 months postoperative vs preoperative values;body weight,BMI,SBP,DBP,FBG,PBG,HbA1c,TC,TG,UA,and HOMA-IR values were all significantly lower 6 months postoperative vs at 3 months;and PCP,Fins,Pins,and HOMA-βwere all significantly higher 6 months postoperative vs at 3 months(all P<0.05).CONCLUSION Side-to-side anastomosis of the jejunum and ileum can effectively treat T2DM and improve the metabolic index levels associated with it.展开更多
BACKGROUND The efficacy of various bariatric surgeries varies in reducing blood glucose levels.Given the distinct mechanisms and anatomical alterations associated with each procedure,it is crucial to compare their gly...BACKGROUND The efficacy of various bariatric surgeries varies in reducing blood glucose levels.Given the distinct mechanisms and anatomical alterations associated with each procedure,it is crucial to compare their glycemic control outcomes.We hypothesize that proximal small intestinal bypass(PSIB)is superior in blood glucose reduction over Roux-en-Y gastric bypass(RYGB)and jejunoileal bypass(JIB).AIM To compare the effectiveness of PSIB,RYGB,and JIB in lowering blood glucose.METHODS Rats with streptozotocin-induced diabetes were randomly divided into PSIB,RYGB,JIB,and sham-operated groups.Body weight,food intake,fasting blood glucose level,oral glucose tolerance test,insulin tolerance test,liver enzymes,and blood lipids were measured.RESULTS Postoperatively,only the JIB group had a lower body weight compared to the sham group.The food intake of the rats in all three surgical groups was significantly less than that in the sham group.Fasting blood glucose was reduced in all surgical groups and was lower in the PSIB group than in the RYGB and JIB groups.Glucose tolerance and insulin sensitivity improved in all three surgical groups compared to the sham group,but the improvement appeared earliest in the PSIB group.At six weeks postsurgery,the PSIB group showed a reduction in alanine transaminase levels and maintained a normal lipid profile.CONCLUSION PSIB demonstrated excellent hypoglycemic effects in the early postoperative period,and had better efficacy than RYGB and JIB.展开更多
In this article,we comment on an article by Wang et al published in the World Journal of Diabetes.Existing treatments with oral medications can partially mitigate the toxicity of elevated blood glucose levels in patie...In this article,we comment on an article by Wang et al published in the World Journal of Diabetes.Existing treatments with oral medications can partially mitigate the toxicity of elevated blood glucose levels in patients with type 2 diabetes mellitus.However,these patients often require lifelong,costly medications,and many struggle with poor compliance.To address the limitations of pharmacological treatments,laparoscopic jejunal-ileal lateral anastomosis has become increasingly common in clinical practice and generally yields favorable outcomes.This procedure stimulates the secretion of larger amounts of glucagon-like peptide-1 by intestinal L cells,which in turn promotes pancreatic islet cell proliferation,reduces insulin resistance,and effectively controls glucose and lipid metabolism disorders.Nonetheless,further research is needed to fully explore its indications,contraindications,the enhancement of patients'quality of life and patients’satisfaction with the subjective experience of treatment and long-term effects.展开更多
In this editorial,I discuss the article by Wang et al,published in the World Journal of Diabetes,which explores jejunoileal side-to-side anastomosis as a novel surgical intervention for type 2 diabetes mellitus(T2DM)....In this editorial,I discuss the article by Wang et al,published in the World Journal of Diabetes,which explores jejunoileal side-to-side anastomosis as a novel surgical intervention for type 2 diabetes mellitus(T2DM).T2DM,often associated with obesity,remains a global health challenge,as sustained remission is difficult to achieve with conventional pharmacological therapy.Jejunoileal anastomosis offers a promising alternative,particularly for patients with normal or relatively high body mass index,and addresses the unique challenges posed by diverse patient populations.This procedure preserves gastric anatomy while simultaneously improving metabolic parameters,such as glycemic control,lipid profiles,and pancreaticβ-cell function.Unlike traditional metabolic surgeries that involve permanent anatomical alterations,this approach provides advantages such as reversibility,shorter operative times,and minimal nutritional complications,making it appealing to patients for whom conventional bariatric surgery is unsuitable.Advances in gut hormone physiology and incretin modulation support these findings.This innovative approach represents a potential paradigm shift in T2DM treatment,offering insights into the evolving role of surgical interventions in metabolic regulation.While early findings show promising diabetes remission rates and metabolic improvements at six months post-surgery,further studies with longer follow-up periods and broader patient cohorts are required.展开更多
Wang et al explored the metabolic improvement effects of jejunoileal side-to-side anastomosis in patients with type 2 diabetes mellitus(T2DM),focusing on its multitarget metabolic regulatory potential through enhanced...Wang et al explored the metabolic improvement effects of jejunoileal side-to-side anastomosis in patients with type 2 diabetes mellitus(T2DM),focusing on its multitarget metabolic regulatory potential through enhanced secretion of glucagon-like peptide-1.This surgical procedure alters the direction of nutrient flow,activates distal ileal L cells,and increases endogenous glucagon-like peptide-1 levels,supporting glucose homeostasis,enhancing insulin sensitivity,regulating body weight,and improving cardiovascular health.This structural adjustment transforms the gastrointestinal tract into an active endocrine regulatory organ,providing a pathway for metabolic improvement in patients with T2DM and other complex metabolic disorders.Although this procedure demonstrates significant metabolic improvements within 3-6 months after surgery,integrating hormone level measurements,metabolic marker analysis,and long-term follow-up has become crucial for exploring the complex mechanisms of T2DM in the field of metabolic surgery and T2DM management.Multidisciplinary collaboration involving support from endocrinology,nutrition,and rehabilitation teams before and after surgery is becoming increasingly vital in the long-term management of patients with T2DM.This collaboration optimizes surgical outcomes and enhances metabolic management.Side-to-side anastomosis shows potential in the multitarget metabolic management of T2DM,providing an additional intervention option for patients with T2DM and metabolic disorders.展开更多
AIM: To analyze systematically our experience over 22 years with symptomatic acquired diverticular disease of the jejunum and ileum, exploring the clinical manifestations and diagnosis of this rare but life-threatenin...AIM: To analyze systematically our experience over 22 years with symptomatic acquired diverticular disease of the jejunum and ileum, exploring the clinical manifestations and diagnosis of this rare but life-threatening disease.METHODS: The medical records of patients with surgically confirmed symptomatic jejunoileal diverticular disease were retrospectively reviewed. Data collected included demographic data, laboratory results, clinical course (acute or chronic), preoperative diagnosis, and operative findings. Inclusion criteria were as follows: (1) surgical confirmation of jejunoileal diverticular disease and (2)exclusion of congenital diverticula (e.g. Meckel's diverticulum).RESULTS: From January 1982 to July 2004, 28 patients with a total of 29 operations met the study criteria. The male:female ratio was 14:14, and the mean age was 62.6±3.5 years. The most common manifestation was abdominal pain. In nearly half of the patients, the symptoms were chronic. Two patients died after surgery. Only four cases were correctly diagnosed prior to surgery, three by small bowel series.CONCLUSION: Symptomatic acquired small bowel diverticular disease is difficult to diagnose. It should be considered in older patients with unexplained chronic abdominal symptoms. A small bowel series may be helpful in diagnosing this potentially life-threatening disease.展开更多
While jejunoileal diverticula are rare and often asymptomatic, they may lead to chronic non-specific or acute symptoms. The large majority of complications present with an acute abdomen similar to appendicitis, cholec...While jejunoileal diverticula are rare and often asymptomatic, they may lead to chronic non-specific or acute symptoms. The large majority of complications present with an acute abdomen similar to appendicitis, cholecystitis or colonic diverticulitis but they also may appear with atypical symptoms. As a result, diagnosis of complicated jejunoileal diverticulosis can be quite difficult, and may solely depend on the result of surgical exploration. In the absence of contra-indications, diagnostic laparoscopy has the benefit of thorough examination of the abdominal contents and helps to reach an absolute diagnosis. Surgical resection of the involved small-bowel segment with primary anastomosis is the preferred treatment in patients with symptomatic complicated jejunoileal diverticular disease. An atypical presentation of complicated jejunal diverticulitis in conjunction with sigmoid diverticulitis diagnosed with laparoscopy and treated with surgical resection is presented.展开更多
Jejunoileal bypass(JIB),popular in the 1960s and 1970s,had remarkable success in achieving weight loss by creating a surgical short bowel syndrome.Our patient had an unusual case of liver disease and provided no histo...Jejunoileal bypass(JIB),popular in the 1960s and 1970s,had remarkable success in achieving weight loss by creating a surgical short bowel syndrome.Our patient had an unusual case of liver disease and provided no history of prior bariatric surgery.Later,it was recognized that he had a JIB in the 1970s,which was also responsible for the gamut of his illnesses.Patients with JIB are often not recognized,as they died of complications,or underwent reversal of their surgery or a liver-kidney transplant.Early identification with prompt reversal,and the recognition and treatment of the life-threatening consequences play a critical role in the management of such patients.展开更多
AIM To compare the outcome between patients with jejunoileal atresia(JIA) associated with cystic meconium peritonitis(CMP) and patients with isolated JIA(JIA without CMP).METHODS A retrospective study was conducted fo...AIM To compare the outcome between patients with jejunoileal atresia(JIA) associated with cystic meconium peritonitis(CMP) and patients with isolated JIA(JIA without CMP).METHODS A retrospective study was conducted for all neonates with JIA operated in our institute from January 2005 to January 2016.Demographics including the gestation age,sex,birth weight,age at operation,the presence of associated syndrome was recorded.Clinical outcome including the type of operation performed,operative time,the need for reoperation and mortality were studied.The demographics and the outcome between the 2 groups were compared.RESULTS During the study period,53 neonates had JIA underwent operation in our institute.Seventeen neonates(32%) were associated with CMP.There was no statistical difference on the demographics in the two groups.Patients with CMP had earlier operation than patients with isolated JIA(mean 1.4 d vs 3 d,P = 0.038).Primaryanastomosis was performed in 16 patients(94%) with CMP and 30 patients(83%) with isolated JIA(P = 0.269).Patients with CMP had longer operation(mean 190 min vs 154 min,P = 0.004).There were no statistical difference the need for reoperation(3 vs 6,P = 0.606) and mortality(2 vs 1,P = 0.269) between the two groups.CONCLUSION Primary intestinal anastomosis can be performed in94% of patients with JIA associated with CMP.Although patients with CMP had longer operative time,the mortality and reoperation rates were low and were comparable to patients with isolated JIA.展开更多
This study examined the effects of a combined surgery of sleeve gastrectomy （SG） and modified jejunoileal bypass （JIB） on the body weight, food intake, and the plasma levels of active glucagon-like peptide-1 （GL...This study examined the effects of a combined surgery of sleeve gastrectomy （SG） and modified jejunoileal bypass （JIB） on the body weight, food intake, and the plasma levels of active glucagon-like peptide-1 （GLP-1） and total ghrelin of rats. Rats were divided into 3 groups in terms of different surgical protocol： SG-JIB （n=12）, SG （n=12）, JIB （n=12） and sham surgery groups （n-10）. In SG-JIB group, rats was subjected to sleeve gastrectomy and end to side anastomosis of part of the jejunum （25 cm from the ligament of Treitz） to the ileum 25 cm proximal to the cecum. The body weight and food intake were evaluated during 10 consecutive weeks postoperatively. The levels of active GLP-1 and total ghrelin in the plasma of the rats were measured by ELISA assay. The results showed that the SG-JIB treated rats relative to SG- or JIB-treated ones produced a sustained reduction in food intake and weight gain. The level of active GLP-1 was elevated and total ghrelin level decreased in SG-JIB-treated rats as compared with SG- or JIB-treated ones. It was concluded that SG-JIB could efficiently reduce the body weight and food intake, alter obesity-related hormone levels of the rats, indicating that SG-JIB may be potentially used for the treatment of obesity.展开更多
Background:Severe jejunoileal atresia is associated with prolonged parenteral nutrition,higher mortality and secondary surgery.However,the ideal surgical management of this condition remains controversial.This study a...Background:Severe jejunoileal atresia is associated with prolonged parenteral nutrition,higher mortality and secondary surgery.However,the ideal surgical management of this condition remains controversial.This study aimed to compare the outcomes of patients with severe jejunoileal atresia treated by three different procedures.Methods:From January 2007 to December 2016,105 neonates with severe jejunoileal atresia were retrospectively reviewed.Of these,42 patients(40.0%)underwent the Bishop–Koop procedure(BK group),49(46.7%)underwent primary anastomosis(PA group)and 14(13.3%)underwent Mikulicz double-barreled ileostomy(DB group).Demographics,treatment and outcomes including mortality,morbidity and nutrition status were reviewed and were compared among the three groups.Results:The total mortality rate was 6.7%,showing no statistical difference among the three groups(P=0.164).The BK group had the lowest post-operative complication rate(33.3%vs 65.3%for the PA group and 71.4%for the DB group,P=0.003)and re-operation rate(4.8%vs 38.8%for the PA group and 14.3%for the DB group,P<0.001).Compared with the BK group,the PA group showed a positive correlation with the complication rate and re-operation rate,with an odds ratio of 4.15[95%confidence interval(CI):1.57,10.96]and 12.78(95%CI:2.58,63.29),respectively.The DB group showed a positive correlation with the complication rate when compared with the BK group,with an odds ratio of 7.73(95%CI:1.67,35.72).The weight-for-age Z-score at stoma closure was–1.22(95%CI:–1.91,–0.54)in the BK group and–2.84(95%CI:–4.28,–1.40)in the DB group(P=0.039).Conclusions:The Bishop–Koop procedure for severe jejunoileal atresia had a low complication rate and re-operation rate,and the nutrition status at stoma closure was superior to double-barreled enterostomy.The Bishop–Koop procedure seems to be an appropriate choice for severe jejunoileal atresia.展开更多
A negative lymph node(NLN)count has been shown to have a significant impact on the prognosis of many types of cancer.However,its prognostic value for jejunoileal neuroendocrine tumors(NETs)remains unclear.In this stud...A negative lymph node(NLN)count has been shown to have a significant impact on the prognosis of many types of cancer.However,its prognostic value for jejunoileal neuroendocrine tumors(NETs)remains unclear.In this study,we investigated the prognostic value of NLN count in patients with resected jejunoileal NETs diagnosed between 1988 and 2014.The data were retrieved from the Surveillance,Epidemiology and End Results database.The X-tile program was used to determine the cutoff value of the NLN count.Univariate and multivariate Cox proportional hazards models were used to assess the prognostic value of NLN count on survival.Harrell concordance index was used to compare the prognostic validity of NLN count with 2 current prognostic systems.The optimal cutoff point of the NLN count was 8.Kaplan-Meier analysis revealed a progressively worse overall survival(OS)with an NLN count≤8 compared with an NLN count>8(P<0.001).Univariate analysis showed that the NLN count,age,tumor site,tumor size and T classification were significant prognostic factors for the OS of jejunoileal NETs,while the number of positive lymph nodes had no significant impact on OS(P=0.513).Multivariate analysis indicated that the NLN count was an independent prognostic factor for OS of jejunoileal NETs.A higher NLN count was associated with better OS(hazards ratio:0.641;95%confidence interval:0.519-0.793;P<0.001).Compared with 2 other prognostic systems,the NLN counts in this study had similar prognostic value in patients with jejunoileal NETs.Our findings suggest that the NLN count is an important independent prognostic factor for patients with jejunoileal NETs,and that it is a good adjunct for disease staging.展开更多
文摘Ulcerative jejunoileitis is an uncommon clinical syndrome consisting of abdominal pain,weight loss associated with diarrhea,and multiple inflammatory ulcerations and strictures of the small bowel.Ulcerative jejunoileitis can complicate established celiac disease or develop in patients de novo.Increased levels of tumor necrosis factor-alpha(TNF-α) in the small intestine of patients with untreated celiac disease are associated with a role in the immune pathogenesis of this disorder.No specific therapy has been shown to change the course of ulcerative jejunoileitis.We report a case of severe ulcerative jejunoileitis previously unresponsive to traditional therapies,including high dose corticosteroids and cyclosporine.The patient had a dramatic resolution of symptoms and a complete normalization of endoscopic findings after anti-TNF-α monoclonal antibody,infliximab(Remicade).
文摘BACKGROUND At present,the existing internal medicine drug treatment can alleviate the high glucose toxicity of patients to a certain extent,to explore the efficacy of laparoscopic jejunoileal side to side anastomosis in the treatment of type 2 diabetes,the report is as follows.AIM To investigate the effect of jejunoileal side-to-side anastomosis on metabolic parameters in patients with type 2 diabetes mellitus(T2DM).METHODS We retrospectively analyzed the clinical data of 78 patients with T2DM who were treated via jejunoileal lateral anastomosis.Metabolic indicators were collected preoperatively,as well as at 3 and 6 months postoperative.The metabolic indicators analyzed included body mass index(BMI),systolic blood pressure(SBP),diastolic blood pressure(DBP),fasting blood glucose(FBG),2-hour blood glucose(PBG),glycated hemoglobin(HbA1c),fasting C-peptide,2-hour C-peptide(PCP),fasting insulin(Fins),2-hour insulin(Pins),insulin resistance index(HOMA-IR),βCellular function index(HOMA-β),alanine aminotransferase,aspartate aminotransferase,serum total cholesterol(TC),low-density lipoprotein cholesterol(L DL-C),triglycerides(TG),high-density lipoprotein,and uric acid(UA)levels.RESULTS SBP,DBP,PBG,HbA1c,LDL-C,and TG were all significantly lower 3 months postoperative vs preoperative values;body weight,BMI,SBP,DBP,FBG,PBG,HbA1c,TC,TG,UA,and HOMA-IR values were all significantly lower 6 months postoperative vs at 3 months;and PCP,Fins,Pins,and HOMA-βwere all significantly higher 6 months postoperative vs at 3 months(all P<0.05).CONCLUSION Side-to-side anastomosis of the jejunum and ileum can effectively treat T2DM and improve the metabolic index levels associated with it.
基金Supported by National Natural Science Foundation of China,No.82360168 and No.81960154Natural Science Foundation of Jiangxi Province,No.20212BAB206020the Foundation of Health Commission of Jiangxi Province,No.SKJP220225830.
文摘BACKGROUND The efficacy of various bariatric surgeries varies in reducing blood glucose levels.Given the distinct mechanisms and anatomical alterations associated with each procedure,it is crucial to compare their glycemic control outcomes.We hypothesize that proximal small intestinal bypass(PSIB)is superior in blood glucose reduction over Roux-en-Y gastric bypass(RYGB)and jejunoileal bypass(JIB).AIM To compare the effectiveness of PSIB,RYGB,and JIB in lowering blood glucose.METHODS Rats with streptozotocin-induced diabetes were randomly divided into PSIB,RYGB,JIB,and sham-operated groups.Body weight,food intake,fasting blood glucose level,oral glucose tolerance test,insulin tolerance test,liver enzymes,and blood lipids were measured.RESULTS Postoperatively,only the JIB group had a lower body weight compared to the sham group.The food intake of the rats in all three surgical groups was significantly less than that in the sham group.Fasting blood glucose was reduced in all surgical groups and was lower in the PSIB group than in the RYGB and JIB groups.Glucose tolerance and insulin sensitivity improved in all three surgical groups compared to the sham group,but the improvement appeared earliest in the PSIB group.At six weeks postsurgery,the PSIB group showed a reduction in alanine transaminase levels and maintained a normal lipid profile.CONCLUSION PSIB demonstrated excellent hypoglycemic effects in the early postoperative period,and had better efficacy than RYGB and JIB.
文摘In this article,we comment on an article by Wang et al published in the World Journal of Diabetes.Existing treatments with oral medications can partially mitigate the toxicity of elevated blood glucose levels in patients with type 2 diabetes mellitus.However,these patients often require lifelong,costly medications,and many struggle with poor compliance.To address the limitations of pharmacological treatments,laparoscopic jejunal-ileal lateral anastomosis has become increasingly common in clinical practice and generally yields favorable outcomes.This procedure stimulates the secretion of larger amounts of glucagon-like peptide-1 by intestinal L cells,which in turn promotes pancreatic islet cell proliferation,reduces insulin resistance,and effectively controls glucose and lipid metabolism disorders.Nonetheless,further research is needed to fully explore its indications,contraindications,the enhancement of patients'quality of life and patients’satisfaction with the subjective experience of treatment and long-term effects.
文摘In this editorial,I discuss the article by Wang et al,published in the World Journal of Diabetes,which explores jejunoileal side-to-side anastomosis as a novel surgical intervention for type 2 diabetes mellitus(T2DM).T2DM,often associated with obesity,remains a global health challenge,as sustained remission is difficult to achieve with conventional pharmacological therapy.Jejunoileal anastomosis offers a promising alternative,particularly for patients with normal or relatively high body mass index,and addresses the unique challenges posed by diverse patient populations.This procedure preserves gastric anatomy while simultaneously improving metabolic parameters,such as glycemic control,lipid profiles,and pancreaticβ-cell function.Unlike traditional metabolic surgeries that involve permanent anatomical alterations,this approach provides advantages such as reversibility,shorter operative times,and minimal nutritional complications,making it appealing to patients for whom conventional bariatric surgery is unsuitable.Advances in gut hormone physiology and incretin modulation support these findings.This innovative approach represents a potential paradigm shift in T2DM treatment,offering insights into the evolving role of surgical interventions in metabolic regulation.While early findings show promising diabetes remission rates and metabolic improvements at six months post-surgery,further studies with longer follow-up periods and broader patient cohorts are required.
基金Supported by the National Natural Science Foundation of China,No.82471616,No.82170418 and No.82271618Natural Science Foundation of Hubei Province,No.2022CFA015+2 种基金Central Guiding Local Science and Technology Development Project,No.2022BGE237Key Research and Development Program of Hubei Province,No.2022BCE001 and No.2023BCB139Hubei Provincial Health Commission Project,No.WJ2023M151。
文摘Wang et al explored the metabolic improvement effects of jejunoileal side-to-side anastomosis in patients with type 2 diabetes mellitus(T2DM),focusing on its multitarget metabolic regulatory potential through enhanced secretion of glucagon-like peptide-1.This surgical procedure alters the direction of nutrient flow,activates distal ileal L cells,and increases endogenous glucagon-like peptide-1 levels,supporting glucose homeostasis,enhancing insulin sensitivity,regulating body weight,and improving cardiovascular health.This structural adjustment transforms the gastrointestinal tract into an active endocrine regulatory organ,providing a pathway for metabolic improvement in patients with T2DM and other complex metabolic disorders.Although this procedure demonstrates significant metabolic improvements within 3-6 months after surgery,integrating hormone level measurements,metabolic marker analysis,and long-term follow-up has become crucial for exploring the complex mechanisms of T2DM in the field of metabolic surgery and T2DM management.Multidisciplinary collaboration involving support from endocrinology,nutrition,and rehabilitation teams before and after surgery is becoming increasingly vital in the long-term management of patients with T2DM.This collaboration optimizes surgical outcomes and enhances metabolic management.Side-to-side anastomosis shows potential in the multitarget metabolic management of T2DM,providing an additional intervention option for patients with T2DM and metabolic disorders.
文摘AIM: To analyze systematically our experience over 22 years with symptomatic acquired diverticular disease of the jejunum and ileum, exploring the clinical manifestations and diagnosis of this rare but life-threatening disease.METHODS: The medical records of patients with surgically confirmed symptomatic jejunoileal diverticular disease were retrospectively reviewed. Data collected included demographic data, laboratory results, clinical course (acute or chronic), preoperative diagnosis, and operative findings. Inclusion criteria were as follows: (1) surgical confirmation of jejunoileal diverticular disease and (2)exclusion of congenital diverticula (e.g. Meckel's diverticulum).RESULTS: From January 1982 to July 2004, 28 patients with a total of 29 operations met the study criteria. The male:female ratio was 14:14, and the mean age was 62.6±3.5 years. The most common manifestation was abdominal pain. In nearly half of the patients, the symptoms were chronic. Two patients died after surgery. Only four cases were correctly diagnosed prior to surgery, three by small bowel series.CONCLUSION: Symptomatic acquired small bowel diverticular disease is difficult to diagnose. It should be considered in older patients with unexplained chronic abdominal symptoms. A small bowel series may be helpful in diagnosing this potentially life-threatening disease.
文摘While jejunoileal diverticula are rare and often asymptomatic, they may lead to chronic non-specific or acute symptoms. The large majority of complications present with an acute abdomen similar to appendicitis, cholecystitis or colonic diverticulitis but they also may appear with atypical symptoms. As a result, diagnosis of complicated jejunoileal diverticulosis can be quite difficult, and may solely depend on the result of surgical exploration. In the absence of contra-indications, diagnostic laparoscopy has the benefit of thorough examination of the abdominal contents and helps to reach an absolute diagnosis. Surgical resection of the involved small-bowel segment with primary anastomosis is the preferred treatment in patients with symptomatic complicated jejunoileal diverticular disease. An atypical presentation of complicated jejunal diverticulitis in conjunction with sigmoid diverticulitis diagnosed with laparoscopy and treated with surgical resection is presented.
文摘Jejunoileal bypass(JIB),popular in the 1960s and 1970s,had remarkable success in achieving weight loss by creating a surgical short bowel syndrome.Our patient had an unusual case of liver disease and provided no history of prior bariatric surgery.Later,it was recognized that he had a JIB in the 1970s,which was also responsible for the gamut of his illnesses.Patients with JIB are often not recognized,as they died of complications,or underwent reversal of their surgery or a liver-kidney transplant.Early identification with prompt reversal,and the recognition and treatment of the life-threatening consequences play a critical role in the management of such patients.
文摘AIM To compare the outcome between patients with jejunoileal atresia(JIA) associated with cystic meconium peritonitis(CMP) and patients with isolated JIA(JIA without CMP).METHODS A retrospective study was conducted for all neonates with JIA operated in our institute from January 2005 to January 2016.Demographics including the gestation age,sex,birth weight,age at operation,the presence of associated syndrome was recorded.Clinical outcome including the type of operation performed,operative time,the need for reoperation and mortality were studied.The demographics and the outcome between the 2 groups were compared.RESULTS During the study period,53 neonates had JIA underwent operation in our institute.Seventeen neonates(32%) were associated with CMP.There was no statistical difference on the demographics in the two groups.Patients with CMP had earlier operation than patients with isolated JIA(mean 1.4 d vs 3 d,P = 0.038).Primaryanastomosis was performed in 16 patients(94%) with CMP and 30 patients(83%) with isolated JIA(P = 0.269).Patients with CMP had longer operation(mean 190 min vs 154 min,P = 0.004).There were no statistical difference the need for reoperation(3 vs 6,P = 0.606) and mortality(2 vs 1,P = 0.269) between the two groups.CONCLUSION Primary intestinal anastomosis can be performed in94% of patients with JIA associated with CMP.Although patients with CMP had longer operative time,the mortality and reoperation rates were low and were comparable to patients with isolated JIA.
基金supported by a grant from Wuhan Municipal Science and Technology Key Project(201060938360-07)
文摘This study examined the effects of a combined surgery of sleeve gastrectomy （SG） and modified jejunoileal bypass （JIB） on the body weight, food intake, and the plasma levels of active glucagon-like peptide-1 （GLP-1） and total ghrelin of rats. Rats were divided into 3 groups in terms of different surgical protocol： SG-JIB （n=12）, SG （n=12）, JIB （n=12） and sham surgery groups （n-10）. In SG-JIB group, rats was subjected to sleeve gastrectomy and end to side anastomosis of part of the jejunum （25 cm from the ligament of Treitz） to the ileum 25 cm proximal to the cecum. The body weight and food intake were evaluated during 10 consecutive weeks postoperatively. The levels of active GLP-1 and total ghrelin in the plasma of the rats were measured by ELISA assay. The results showed that the SG-JIB treated rats relative to SG- or JIB-treated ones produced a sustained reduction in food intake and weight gain. The level of active GLP-1 was elevated and total ghrelin level decreased in SG-JIB-treated rats as compared with SG- or JIB-treated ones. It was concluded that SG-JIB could efficiently reduce the body weight and food intake, alter obesity-related hormone levels of the rats, indicating that SG-JIB may be potentially used for the treatment of obesity.
基金supported by the Science and Technology Planning Project of Guangdong Province(2014A020212022).
文摘Background:Severe jejunoileal atresia is associated with prolonged parenteral nutrition,higher mortality and secondary surgery.However,the ideal surgical management of this condition remains controversial.This study aimed to compare the outcomes of patients with severe jejunoileal atresia treated by three different procedures.Methods:From January 2007 to December 2016,105 neonates with severe jejunoileal atresia were retrospectively reviewed.Of these,42 patients(40.0%)underwent the Bishop–Koop procedure(BK group),49(46.7%)underwent primary anastomosis(PA group)and 14(13.3%)underwent Mikulicz double-barreled ileostomy(DB group).Demographics,treatment and outcomes including mortality,morbidity and nutrition status were reviewed and were compared among the three groups.Results:The total mortality rate was 6.7%,showing no statistical difference among the three groups(P=0.164).The BK group had the lowest post-operative complication rate(33.3%vs 65.3%for the PA group and 71.4%for the DB group,P=0.003)and re-operation rate(4.8%vs 38.8%for the PA group and 14.3%for the DB group,P<0.001).Compared with the BK group,the PA group showed a positive correlation with the complication rate and re-operation rate,with an odds ratio of 4.15[95%confidence interval(CI):1.57,10.96]and 12.78(95%CI:2.58,63.29),respectively.The DB group showed a positive correlation with the complication rate when compared with the BK group,with an odds ratio of 7.73(95%CI:1.67,35.72).The weight-for-age Z-score at stoma closure was–1.22(95%CI:–1.91,–0.54)in the BK group and–2.84(95%CI:–4.28,–1.40)in the DB group(P=0.039).Conclusions:The Bishop–Koop procedure for severe jejunoileal atresia had a low complication rate and re-operation rate,and the nutrition status at stoma closure was superior to double-barreled enterostomy.The Bishop–Koop procedure seems to be an appropriate choice for severe jejunoileal atresia.
基金supported by the National Natural Science Foundation of China(No.81573007 to YD,81572361 to WH)the Ten Thousand Plan Youth Talent Support Program of Zhejiang Province,China(to WH)+3 种基金the Zhejiang Natural Sciences Foundation of China(No.LQ18H160008 to HL)the Zhejiang Medical Science and Technology Project,China(No.2016KYB290 to XY)the Zhejiang Province Preeminence Youth Fund,China(No.LR16H160001 to WH)the Zhejiang Medical Innovative Discipline Construction Project-2016,China(to WH).
文摘A negative lymph node(NLN)count has been shown to have a significant impact on the prognosis of many types of cancer.However,its prognostic value for jejunoileal neuroendocrine tumors(NETs)remains unclear.In this study,we investigated the prognostic value of NLN count in patients with resected jejunoileal NETs diagnosed between 1988 and 2014.The data were retrieved from the Surveillance,Epidemiology and End Results database.The X-tile program was used to determine the cutoff value of the NLN count.Univariate and multivariate Cox proportional hazards models were used to assess the prognostic value of NLN count on survival.Harrell concordance index was used to compare the prognostic validity of NLN count with 2 current prognostic systems.The optimal cutoff point of the NLN count was 8.Kaplan-Meier analysis revealed a progressively worse overall survival(OS)with an NLN count≤8 compared with an NLN count>8(P<0.001).Univariate analysis showed that the NLN count,age,tumor site,tumor size and T classification were significant prognostic factors for the OS of jejunoileal NETs,while the number of positive lymph nodes had no significant impact on OS(P=0.513).Multivariate analysis indicated that the NLN count was an independent prognostic factor for OS of jejunoileal NETs.A higher NLN count was associated with better OS(hazards ratio:0.641;95%confidence interval:0.519-0.793;P<0.001).Compared with 2 other prognostic systems,the NLN counts in this study had similar prognostic value in patients with jejunoileal NETs.Our findings suggest that the NLN count is an important independent prognostic factor for patients with jejunoileal NETs,and that it is a good adjunct for disease staging.
