胃切除术后不同消化道重建方式对胃癌合并2型糖尿病患者血糖影响的临床回顾性研究

Retrospective study of the influence of alimentary tract reconstruction after gastrectomy on the blood glucose level in patients with gastric cancers combined with type 2 diabetes mellitus

目的探讨胃切除术后不同消化道重建方式对胃癌合并2型糖尿病患者血糖的影响。方法回顾性分析2004年1月至2009年12月87例胃癌合并2型糖尿病患者接受不同消化道重建手术前后空腹血糖及体重的变化情况，其中行胃远端大部切除术并行毕I式吻合48例（A组），行全胃切除术并行食管空肠Roux-en—Y吻合重建39例（B组）。结果A组手术前后空腹血糖水平比较差异无统计学意义（P〉0．05）；B组空腹血糖水平术后1个月[（6．7±0．8）mmol／L]、术后3个月[（6．6±0．6）mmol／L]、术后6个月[（6．8±0．7）mmol／L]与术前[（9．7±1．4）mmol／L]比较差异有统计学意义（P〈0．05）；同时B组术后1、3、6个月空腹血糖水平与A组比较差异有统计学意义（P〈0．05）。B组术后6个月总有效率为87．2％（34／39）。两组手术前后体重比较差异均有统计学意义（P〈0．05），但两组之间各时间点体重比较差异无统计学意义（P〉0．05）。结论胃切除术后行食管空肠Roux-en-Y吻合重建对胃癌合并2型糖尿病患者有明显的治愈作用，而且术后1个月即显效，并与体重下降无关。

[ Abstract ] Objective To explore the influence of alimentary tract reconstruction after gastrectomy on the blood glucose level in patients with gastric cancers combined with type 2 diabetes mellitus. Methods From January 2004 to December 2009, the level of blood glucose and body weight before operation and 1,3,6 months after operation in 87 gastric cancer combined with type 2 diabetes mellitus patients were retrospectively analyzed. These patients underwent different alimentary tract reconstructions,including 48 patients for Billroth I after distal subtotal gastrectomy （group A）,39 patients for esophageal Roux-en-Y jejunostomy after total gastrectomy （group B）. Fasting blood glucose （FBG） level and body weight of these patients were compared. Results In group A, change of FBG before and after operation were not significant （P 〉 0.05 ）. The levels of FBG in group B were significantly tower in 1,3,6 months after operation [ （6.7 ± 0.8）, （6.6 ±0.6）, （6.8±0.7） mmol/L] than that before operation [（9.7 ± 1.4） mmol/L]（P〈0.05）. The lower value average difference of FBG at 1,3,6 months was significant between group A and group B （P 〈 0.05 ）. In group B ,6 months after operation＇s total effective rate was 87.2% （34/39）. Changes of body weight before and after operation in group A and group B were significant （P 〈 0.05 ）. But between two groups, the changes of body weight between 1,3,6 months and before operation were not significant （P 〉0.05）. Conclusions Esophageal Roux-en-Y jejunostomy after total gastrectomy has obvious influence on FBG level in patients with gastric cancers combined with type 2 diabetes mellitus. It takes about 1 month to reveal the effect of operation and has nothing to do with weight loss.