胃大部切除术对胃病合并糖尿病患者糖代谢的影响

Effect of subtotal gastrectomy on glucose metabolism in patients with gastric disease combined with diabetes memtus

目的探讨胃大部切除术对胃病合并糖尿病患者糖代谢的影响。方法对126例接受胃大部切除术的胃病合并糖尿病患者的临床资料进行回顾性分析，其中Billroth II式胃大部切除术患者69例（Billroth II式组），BillrothI式胃大部切除术患者57例（BillrothI式组），比较两组术前及术后1、3、6个月空腹血糖、餐后2h血糖的变化及糖代谢改善情况。结果BillrothI式组术后1、3、6个月空腹血糖及餐后2h血糖与术前比较差异无统计学意义（P〉0．05）；Billroth II式组术后3、6个月空腹血糖及餐后2h血糖分别为（10．7±2．9）、（10．4±2．3）mmol／L和（12．4±2．6）、（12．0±3．2）mmol／L，与术前及术后1个月的（14．1±3．2）、（13．4±3．8）mmol／L和（19．0±3．9）、（18．1±4．3）mmol／L比较差异有统计学意义（P〈0．05或〈0．01）。BillrothI式组糖代谢改善4例，无效53例，改善率为7．02％（4／57），BillrothlI式组糖代谢改善64例，无效5例，改善率为92．75％（64／69），两组改善率比较差异有统计学意义（P〈0．01）。结论胃大部切除术对改善胃病合并糖尿病患者的糖代谢具有明显的效果，并且采用BillrothII式胃大部切除术患者比采用BillrothI式胃大部切除术患者糖代谢的改善率明显提高。

Objective To investigate the effect of subtotal gastrectomy on glucose metabolism in patients with gastric disease combined with diabetes mellitus. Methods The clinical data of 126 cases with gastric disease combined with diabetes mellitus receiving subtotal gastreetomy were analyzed retrospectively, including subtotal gastrectomy Billroth II type 69 patients （Billroth II type group）, subtotal gastrectomy Billroth I type 57 patients （Billroth I type group）. The fasting blood glucose, postprandial blood glucose before surgery and 1, 3,6 months after surgery and the improvement of glucose metabolism were compared. Results There was no significant difference in the fasting blood glucose, postprandial blood glucose before surgery and 1,3,6 months after surgery in Billroth I type group （P 〉 0.05）. The fasting blood glucose, postprandial blood glucose 3,6 months after surgery[ （ 10.7 ± 2.9）, （ 10.4 ± 2.3） mmol/L and （ 12.4 ± 2.6）, （12.0 ±3.2） mmol/L] were higher than those before surgery and 1 month after surgery [（14.1 ±3.2）, （13.4 ±3.8） mmol/L and （19.0 ±3.9）, （18.1 ±4.3） mmol/L] in Billroth II type group with significant differences （P〈 0.05 or 〈 0.01 ）. The improving rate of glucose metabolism in Billroth I type group [7.02% （4/57） ] was lower than that in Billroth II type group [ 92.75%（64/69 ） ] with significant difference（P 〈 0.01 ）. Conclusions Subtotal gastrectomy has obvious effect on improving glucose metabolism in patients with gastric disease combined with diabetes mellitus. The use of subtotal gastrectomy Billroth II type is prior to subtotal gastrectomy Billroth I type.