胃窦部癌合并2型糖尿病患者消化道重建方式的选择

Choice of Digestive Tract Reconstruction to Gastric Antral Cancer Patients with Type 2 Diabetes

目的探讨胃窦部癌合并2型糖尿病患者采取不同消化道重建方式后对患者血糖的影响。方法回顾性分析我院2006年1月至2012年1月期间行根治性手术治疗的51例胃窦部癌合并2型糖尿病患者的临床资料,根据消化道重建方式不同分为BillrothⅠ式组(14例)、BillrothⅡ式组(28例)及Roux-en-Y组(9例)3组,对比分析3组以下指标:①比较3种重建方式患者术前、术后1个月及术后6个月的空腹血糖(FBG)、餐后2 h血糖(PG2h)水平;②术前、术后6个月糖化血红蛋白(HbA1c)的水平;③3组糖尿病的控制情况。结果 BillrothⅠ式组术后1个月和术后6个月的FBG、PG2h水平与术前比较差异均无统计学意义(P>0.05),BillrothⅡ式组和Roux-en-Y组术后1个月和术后6个月的FBG、PG2h水平均明显低于术前(P<0.05);术后1个月和术后6个月的FBG、PG2h水平,BillrothⅡ式组和Roux-en-Y组间比较,差异均无统计学意义(P>0.05),但BillrothⅡ式组和Roux-en-Y组均明显低于BillrothⅠ式组(P<0.05)。BillrothⅠ式组术前与术后6个月间的HbA1c水平比较,差异无统计学意义(P>0.05);BillrothⅡ式组和Roux-en-Y组术后6个月HbA1c值均明显低于术前(P<0.05)。术后6个月,BillrothⅡ式组和Roux-en-Y组的HbA1c值均分别明显低于BillrothⅠ式组(P<0.05);BillrothⅡ式组和Roux-en-Y组间的HbA1c值比较,差异无统计学意义(P>0.05)。BillrothⅡ式组和Roux-en-Y组患者总体疗效均分别明显优于BillrothⅠ式组患者(P=0.000,P=0.000),BillrothⅡ式组和Roux-en-Y组间比较差异均无统计学意义(P=0.259)。结论根据本组有限病例资料的研究表明,BillrothⅡ式吻合及Roux-en-Y吻合对于胃窦部癌合并2型糖尿病的患者可能是最佳的手术方式。

Objective To assess the influence of different digestive tract reconstruction on the blood glucose of gastric antral cancer patients with type 2 diabetes. Methods The clinical data of 51 cases of gastric antral cancer with type 2 diabetes treated radical surgery in this hospital from January 2006 to January 2012 were analyzed retrospectively. The patients were divided into three groups according to the different digestive tract reconstruction methods： Billroth I anastomosis group （n：14）, Billroth II anastomosis group （n=28）, and Roux-en-Y anastomosis group （n：9）. The indexes were analyzed and compared among three groups： ① The levels of fast blood glucose （FBG） and 2 h postprandial blood glucose （PG2h） were detected before operation and on 1 month and 6 months after the operation; ② The level of glycated hemoglobin （HbAlc） was detected before operation and 6 months after the operation; ③ The diabetes control was observed. Results The FBG and PG2h levels in the Billroth I anastomosis group detected on 1 month and 6 months after the operation were not statistically different from those detected before the operation （P〉0. 05）. The FBG and PG2h