远端胃大部切除术后不同消化道重建方式对糖耐量及胰岛素反应的对比研究

Oral glucose tolerance test and insulin response in Beagle dogs after subtotal distal gastrectomy

目的评估远端胃大部切除术后连续性空肠间置对餐后血糖和胰岛素的影响。方法将38只比格犬行远端胃大部切除术，根据不同消化道重建方式分为连续间置组（9只）、毕Ⅰ组（6只）、毕Ⅱ组（7只）、孤立间置组（8只）和对照组（8只）。通过口服糖耐量试验检测各组实验犬血糖和胰岛素水平的变化。结果与对照组相比，葡萄糖灌注后各消化道重建组血糖均显著升高，60min达到峰值．尤以毕Ⅱ组升高最为显著：之后血糖开始回落．以毕Ⅱ组回落最为缓慢。与对照组相比．葡萄糖灌注后各消化道重建组胰岛素水平均显著升高．60min达到峰值．但毕Ⅱ组升高不如其他3组显著。结论保留十二指肠食物通道（连续空肠间置、毕Ⅰ和孤立间置）有利于缓和远端胃大部分切除术后餐后血糖的波动．并提高相应胰岛素水平：对于胃大部切除术后不能行毕Ⅰ重建者．可优先考虑行连续性空肠间置。

Objective To evaluate the impact of reconstruction techniques after subtotal gastrectomy on postoperative glucose and insulin levels after oral glucose tolerance test （OGTT）. Methods Distal gastrectomy was performed in 38 Beagle dogs. Reconstruction techniques used included integral continual jejunal interposition （n=9）, Billroth Ⅰ （n = 6）, Billroth Ⅱ （n=7）, and isolated jejunal interposition （n=8）. Eight controls were used. OGTT was conducted to examine the changes in glucose and insulin levels. Results Compared to controls, glucose significantly increased in all the 4 operative groups and peaked at 60 min. Billroth Ⅱ was associated with the most significant increase. Insulin level significantly increased in all the experimental groups in response to food stimulus and peaked at 60 min. However, the increase of insulin in Billroth Ⅱ group was not as prominent as in other groups. Conclusions Fluctuation of blood glucose after gastrectomy may be mitigated and insulin elevated if duodenal passage is preserved. Continual jejunal interposition should be given priority when Billroth Ⅰ reconstruction is not feasible.