2型糖尿病合并胃癌行胃切除后不同消化道重建对血糖代谢的影响

Effect of different alimentary reconstruction after radical surgery for gastric cancer on blood glucose in patients with type 2 diabetes mellitus

目的探讨2型糖尿病合并胃癌行胃切除后不同消化道重建方式对2型糖尿病患者血糖代谢的影响。方法选取2008年1月至2012年1月在第二军医大学长海医院普外科就诊的胃癌合并2型糖尿病的胃切除患者66例为研究对象，按照胃肠道重建方式进行分组，分为胃远端大部切除术并行毕Ⅰ式吻合组（A组，26例）和胃远端大部切除术并行毕Ⅱ式吻合组（B组，40例）。观察2组患者术前年龄、病程、体质指数（BMI）、糖化血红蛋白（HbA1c）、胰岛素剂量、空腹血糖（FPG）、餐后2h血糖（2hPG），比较2组患者术后1周及3个月FPG、2hPG的变化。组间比较采用方差分析。结果A组手术前后FPG和2hPG差异均无统计学意义（均P〉0．05）。B组术后1周、术后3个月FPG及2hPG与术前比较差异均有统计学意义[分别为FPG：（7．0±0．6）比（6．1±0．4）比（10．2±1．0）mmol／L，F=4．25，P〈0．05；2hPG：（8．8±0．1）比（7．3±1．1）比（11．4±1．8）mmol／L，F=3．87，P〈0．05]；同时B组术后1周及术后3个月FPG及2hPG与A组比较差异均有统计学意义[分别为FPG：术后1周为（7．0±0．6）比（10．0±0．7）mmol／L，t=5．35，P〈0．05；术后3个月为（6．1±0．4）比（9．8±0．7）mmol／L，t=4．78，P〈0．05；2hPG：术后1周为（8．8±0．1）比（12．3±0．5）mmol／L，t=6．12，P〈0．05；术后3个月为（7．3±1．1）比（11．7±0．6）mmol／L，江6．78，P〈0．05]。结论胃远端大部切除术行毕Ⅱ式吻合重建对胃癌合并2型糖尿病患者的高血糖有明显的缓解作用。

Objective To explore the effect of alimentary tract reconstruction after gastrectomy on blood glucose in patients with gastric cancer complicated with type 2 diabetes mellitus （T2DM）. Methods The clinical data was retrospectively analyzed in 66 cases who received radical surgery for gastric cancer with T2DM from January 2008 to January 2012 in Changhai Hospital. These patients were divided into two groups according to different types of digestive tract reconstruction ： Billroth Ⅰ （ n = 26, group A） and Billroth 11 （n = 40, group B）. The preoperative clinical features, including the age, course of T2DM, body mass index （BMI）, glycated hemoglobin Ale （HbAlc）, insulin dosage, fasting plasma glucose （FPG） and 2-hour postprandial plasma glucose（2 h PG） , were observed and compared between the two groups. And on the time of one week and three months after surgery, the FPG, 2 h PG were compared between the both two groups. The data were compared by using analysis of variance. Results There was no statistical difference in FPG and 2 h PG before and after operation in group A （ both P 〉 0.05 ）. The FPG and 2 h PG in group B decreased significantly one week and three months after operation when compared with those before operation （FPG：（7.0 ±0.6） vs （6.1 ±0.4） vs （10.2 ±1.0） mmo]/L, F=4.25, P〈0.05; 2 h PG：（8.8 ±0. 1） vs （7.3±1.1） vs （11.4±1.8） retool/L, F=3.87, P〈0.05）. Moreover, theFPGand2hPGingroup B were all significantly lower than those in group B one week and three months after the operation （FPG at one week after surgery （7.0 ± 0.6） vs（ 10.0 ± 0.7） mmol/L , t = 5.35, P 〈 0.05, and three months after operation （6.1 ± 0.4 ） vs （ 9.8 ± 0.7 ） mmol/L, t = 4.78, P 〈 0.05 ; 2 h PG at one week after surgery（8. 8 ± 0.1 ） vs （ 12.3 ± 0.5 ） mmol/L, t = 6.12,P 〈 0.05, and three months after operation （7.3 ± 1.1 ） vs （11.7 ±0.6） mmol/L, t =6.78, P 〈0.05）. Conclusion The Billroth Ⅱanastomosis reconstruction for distal gastrectomy brings remarkable effects on hyperglycemia in patients with gastric cancer and T2DM,