胃癌根治手术消化道重建方式对合并2型糖尿病患者血糖的影响

Effect of Three Procedures of Digestive Tract Reconstructions after Distal Gastrectomy on Blood Sugar of Gastric Cancer Patients Complicated with Diabetes

目的:评价三种胃切除术对合并2型糖尿病患者血糖的影响。方法:手术治疗合并2型糖尿病的远端胃癌64例,行BillrothⅠ术式8例(A组),BillrothⅡ术式32例(B组),Roux-en-Y术式24例(C组)。结果:64例均成功完成根治性胃切除术,A组血糖术前与术后各时间点均无明显差异(P>0.05),术后第1月为(7.36±1.25)mmol/L,术后第9月为(9.06±1.26)mmol/L(P<0.05)。B、C两组术后血糖与术前有显著性差异(P<0.05),糖尿病改善的总有效率分别为76.8%(43/56);39.3%(22/56)痊愈。结论:对于合并糖尿病的远端胃癌病人,BillrothⅡ式或Roux-en-Y式能有效改善病人的糖代谢,同时也为糖尿病手术治疗提供了可行性依据。

Objective To study the effect of three procedures of digestive tract reconstruction after distal gastrectomy on blood sugar of gastric cancer patients complicated with diabetes. Methods The variation of blood sugar level in 64 patients of gastric cancer complicated with diabetes after distal gastrectomy was retrospectively analyzed. These patients were assigned to 3 groups by different digestive tract reconstruction： （A） Billroth I： 8 cases （B） Billroth II： 32 cases and （C） Roux-en-Y： 24 cases. Results All 64 patients survived the operation and no severe postoperative complications occurred. In group A three was no difference between preoperative and postoperative fasting blood glucose level （FBG）, FBG of group A in the first month after operation was 7.36±1.25 mmol/L, but increased to 9.06±1.26 mmol/L in the ninth month after operation. The total effective rate in group B and group C was 76.8% （43/56） including 22 healed （39.3%）. Conclusion Improvement of the glycometabolism after Billroth II or Roux-en-Y distal gastrectomy suggests the feasibility of healing diabetes surgically.