胃转流术对合并2型糖尿病胃癌患者血糖的影响：附67例临床报告

Influence of alimentary tract reconstruction on gastric cancer patients complicated with type 2 diabetes mellitus （ a report of 67 cases ）

目的探讨胃转流术对合并2型糖尿病胃癌患者血糖的影响。方法对67例有完整资料的合并2型糖尿病胃癌患者术前、术后1个月，术后3、6个月的血糖值行回顾性分析。其中BMI〈25kg/^2m。53例，25-29．9kg／m^2 9例，〉30kg／m^2 9例。根治性全胃切除＋空肠P襻Roux-en-y吻合术26例，根治性全胃切除＋改良式食管空肠Roux-en-y吻合术11例，根治性远端胃次全切除＋改良式残胃空肠Roux-en-y吻合术30例。结果67例手术均获成功。术前早晨空腹血糖平均为9．6±3．3mmol／L；术后1个月平均为7．4±2．6mmol／L，3个月平均为7．54±2．3mmol／L，6个月平均为7．7±2．9mmol／L；术后1个月与术前早晨空腹血糖比较，P〈0．05，有统计学意义。术后3个月、6个月与术后1个月的早晨空腹血糖比较，无统计学意义。结论胃转流术对正常人群2型糖尿病有明显的治疗作用，术后1个月即可显效，有很好的临床应用前景，其机制有待进一步研究。

Objective To explore the influence of alimentary tract reconstruction on blood glucose level in gastric cancer patients complicated with type 2 diabetes mellitus. Methods Clinical data of 67 gastric cancer patients complicated with type 2 diabetes mellitus and the level of blood glucose before operation, one month, three month, six month after operation were retrospectively analyzed. BMI of 53 patients was lower than 25kg/m^2 ,9 patients between 25 -29.9 kg/m^2 and 5 patients was higher than 30kg/m^2. Total gastrectomy with P- type jejunal pouch Roux-en-Y esophagojejunostomy was performed in 26 cases, and total gastrectomy with Roux-en-y esophagojejunostomy was performed in 11 cases, distal subtotal gastrectomy with Roux-en-y gastrojejunostomy in 30 cases. Results Operations on sixty-seven patients were all uneventfully. The mean fasting blood glucose level in the morning was 9.6 ± 3.3 mmol/L before operation, 7.4 ± 2.6 mmol/L one month after operation, 7.5 ± 2.3 mmol/L three month after operation, and 7.7 ± 2.9 mmol/L six month after operation. There were significant differences between the blood glucose level of before operation and one month after operation （P 〈 0.05 ）, and there were no significant differences between three month, six month and one month after operation （ P 〉 0.05）. Conclusions Alimentary tract reconstruction has obviousinfluence on blood glucose level in type 2 diabetes mellitus patients. It takes about one month for reveal the effect of operation. This phenomenon is of value for clinical application. Its mechanism needs further research.