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Mechanisms of Improvement of Glucose Metabolism in Patients with Type 2 Diabetes Mellitus after Treatment with Bariatric Surgery

A Multicenter Randomized Controlled Clinical Trial on Potassium and Magnesium Supplementary Effects of Potassium Aspartate and Magnesium Aspartate Injection in Gastrointestinal Surgery Patients During Absolute Fasting

Objective　To evaluate the safety and efficacy of potassium and magnesium supplement with potassium aspartate and magnesium aspartate injection in gastrointestinal surgery patients during absolute fasting．Methods　A multicenter randomized controlled clinical trial was conducted in 111 patients after gastrointestinal surgery. For trial group，56 patients were given potassium aspartate and magnesium aspartate injection （Panangin®） in half of the total potassium replenished dose and the rest half of the potassium replenished dose was given in 10% potassium chloride injection．For control group，55 patients were given 10% potassium chloride injection for the total dose of potassium replenished．Such treatments maintained five consecutive days after surgical operation．Clinical observations were performed until patients were discharged from the hospitals．Results　Before the intervention，there were no significant differences for the baseline between two groups （P＞0.05）．There was no significant difference for the serum potassium level between two groups （P＞0.05） after intervention．The amount of urinary potassium （mmol/24 h） for patients in the trial group was significantly lower than that in the control group during treatment after operation．The serum magnesium level of control group was much lower than that of control group （P＜0.05）. In the clinical observation process，no drug-related adverse event was observed．Conclusions　The supplementary effect of potassium and magnesium for potassium aspartate and magnesium aspartate injection in patients with gastrointestinal surgery during absolute fasting is significant，and superior to potassium chloride injection for potassium supplement．Potassium aspartate and magnesium aspartate injection is a safe and appropriate choice for patients with potassium depletion．

Prevention and Management of Iatrogenic Splenic Injury During Laparoscopic Gastroenteric Surgery

目的　探讨腹腔镜胃肠道手术中医源性脾损伤的发生原因和处理方法。方法　回顾性分析我院2007年12月至2009年2月期间125例行腹腔镜胃肠手术中出现的5例医源性脾损伤的临床资料。结果　5例脾损伤患者中腹腔镜胃手术4例，腹腔镜结肠手术1例； 按Pachter脾损伤分级，Ⅰ级3例，Ⅱ级2例。所有患者均经腹腔镜手术治疗治愈，电凝止血1例,小纱布压迫加电凝加止血纱布压迫止血4例。结论　腹腔镜胃肠手术中发生的脾损伤多为表浅的Ⅰ、Ⅱ级损伤,及时发现及正确处理十分重要。

不规范使用管状吻合器导致吻合口梗阻（附 40 例报道）

目的 探讨胃肠外科手术中不规范使用管状吻合器而导致吻合口梗阻发生的原因及预防对策。 方法 回顾性分析 2005 年 7 月至 2016 年 7 月期间于笔者所在医院接受胃肠道手术且在术中使用管状吻合器后发生吻合口梗阻的 40 例患者的临床资料，分析患者的吻合口类型、梗阻发生部位、梗阻类型及梗阻发现时间及处理。 结果 ① 吻合口类型有：小肠端侧吻合口 33 例，食管空肠端侧吻合口 2 例，回肠结肠端侧吻合口 3 例，结肠直肠端侧吻合口 2 例。② 梗阻发生的部位：小肠吻合口梗阻 37 例，结肠吻合口梗阻 3 例。③ 梗阻类型有：完全梗阻 37 例，部分梗阻 3 例。④ 梗阻发现时间及处理：术中发现吻合口梗阻 35 例，及时进行重新吻合；术后发现吻合口梗阻 5 例，行二次手术重新吻合。 结论 若管状吻合器使用不规范，吻合器杆插入肠腔向前移动时，会导致黏膜及黏膜下层在肠管内纵向滑动，对侧的黏膜及黏膜下层被钉入吻合口，从而引起吻合口梗阻；精湛的吻合技术、大小合适的吻合器以及术后常规检查吻合口是否通畅，均能有效地避免因吻合器使用不规范而导致的吻合口梗阻。

Perioperative nutritional management in electively gastrointestinal surgery

Objective To summarize the nutritional management strategies of patients undergoing electively gastrointestinal surgery. Methods This article reviewed the recent researches on perioperative nutritional management in electively gastrointestinal surgery, including four major directions: preoperative nutritional evaluation, glucose level control, nutritional type, and immunonutrition. Results At present, preoperative nutritional evaluation methods included anthropometry, laboratory tests, subjective global assessment (SGA), nutritional risk screening (NRS) 2002, Reilly nutritional risk screening, nutritional risk indicator (NRI), and so on. For preoperative nutritional assessment system, however, current data could not single out superiority for any nutritional assessment methods in the ability to predict surgery-related complications. The usage of enhanced recovery after surgery (ERAS) protocol to reduce surgical stress and preclude postoperative insulin resistance had recently been clearly linked to reductions in postoperative morbidity and adverse outcomes. There were specific criterias for perioperative parenteral and enteral nutrition in undernourished patients, who were defined in clinical guidelines recently, such as the Guidelines for Adult Perioperative Nutrition Support issued by Chinese Society of Parenteral and Enteral Nutrition (CSPEN). Several systematic reviews showed that immunonutrition could reduce both morbidity and length of stay after major electively gastrointestinal surgery. Conclusion Perioperative nutritional management can ensure patients benefit from nutritional support by nutritional assessment, can reduce the nutritional risk and metabolic disorder caused by operation, can achieve the goal of optimal nutrition support in surgical patients, and can ultimately reduce postoperative complications.

Research progress of gut microbiome influences on anastomotic leakage following gastrointestinal surgery

ObjectiveTo explore gut microbiome influences on anastomotic healing following gastrointestinal surgery and its mechanism.MethodThe relevant literatures about gut microbiome and its impact on healing of gastrointestinal anastomosis and their mechanisms were reviewed.ResultsSeveral symbiotic intestinal microbiota such as the Enterococcus faecalis, Pseudomonas aeruginosa, Serratia marcescens, etc. could transform into the pathogenic bacteria with high toxic phenotype in an inflammatory environment in the body, and dissolve the extracellular matrix by degrading collagen or activating matrix metalloproteinase 9, resulting in the anastomotic leak.ConclusionIn general, exploring of effect of intestinal microbiome on healing process of anastomotic stoma is just beginning, conditions and mechanisms for transformation of bacteria from symbiotic to pathogenic still need to be explored.

Analysis in the influencing factor of intraoperative hypothermia during laparotomy

ObjectiveTo investigate the influencing factor of intraoperative hypothermia during laparotomy.MethodsA total of 81 patients underwent laparotomy in our hospital from October 1, 2018 to January 1, 2019 were enrolled. The difference of preoperative baseline data and surgical data between the hypothermia and non-hypothermia groups was compared, and the influencing factor of intraoperative hypothermia during laparotomy was explored.ResultsOf the 81 patients, 32 patients occurred hypothermia during operation. There were no significant differences in gender, age, BMI, HGB, WBC count, PLT count, TB, AST, ALT, ALB, PT, operation time, postoperative hospital stay, and Clavien-Dindo grade between the hypothermia group and the non-hypothermia group (P>0.05), but there were significant differences in intraoperative infusion volume, intraoperative blood loss, and surgical mode (P<0.05). The intraoperative infusion volume and intraoperative blood loss in the hypothermia group were higher than those in the non-hypothermia operation group, and the proportion of hepatectomy was higher than that in the non-hypothermia group. The multivariate analysis show that the intraoperative blood loss, intraoperative infusion volume, and kind of operation were the risk factors for the hypothermia during laparotomy (P<0.05).ConclusionsIntraoperative hypothermia is related to intraoperative bleeding volume, intraoperative fluid infusion volume, and the kind of operation. Therefore, for patients with less bleeding, the intraoperative hypothermia can be reduced by limiting the volume of intraoperative fluid infusion. For those patients with more intraoperative bleeding, warming fluid infusion may reduce the incidence of intraoperative hypothermia.