腹腔镜与开腹胃癌根治术后胰岛素抵抗的变化及临床意义

Comparison of changes in insulin resistance and its clinical significance between laparoscopic and open radical gastrectomy for stomach cancer

目的:观察腹腔镜与开腹胃癌根治术后早期胰岛素抵抗(insulin resistance,IR)的变化,探讨两种术式对IR的影响及其临床意义。方法:选择近期胃癌手术患者126例,分为腹腔镜组与开腹组,检测术前及术后第1天、第4天、第7天空腹血糖(fasting blood glucose,FBG)、空腹胰岛素(fasting insulin,FINS)水平,利用稳态模式评估法(homeostasis model assessment,HOMA)计算胰岛素抵抗指数(insulin resistance index,HOMA-IR)。结果:两组患者手术时间、出血量差异有统计学意义(P<0.05)。与术前相比,术后第1天、第4天两组患者HOMA-IR、FBG、FINS差异均有统计学意义(P<0.05)。两组间相比,术前FBG、FINS、HOMA-IR差异无统计学意义(P>0.05),术后第1天、第4天腹腔镜组低于开腹组,差异有统计学意义(P<0.01)。结论:腹腔镜手术可降低术后HOMA-IR,减轻IR程度,利于患者的术后康复。

Objective：To observe the early changes of insulin resistance （IR） after laparoscopic and open radical gastrectomy for gastric cancer,and to explore the effect and clinical significance of these two procedures on the IR. Methods： One hundred and twenty-six patients with recent diagnosed gastric cancer were randomly divided into laparoscopic group and open group. The fasting blood glucose （FBG） and fasting insulin （FINS） levels were measured before operation and 1,4,7 days after the surgery. And insulin resistance index （HOMA-IR） was calculated using the homeostasis model assessment （HOMA）. Results：The operation time and blood loss showed statistically significant difference between the two groups （P 〈 0.05 ）. Compared with the preoperative levels, HOMA-IR, FBG, FINS in both groups showed statistically significant difference in 1 and 4 days after operation （ P 〈 0.05 ）. Though preoperative FBG,FINS,and HOMA-IR showed no significant difference between both groups （ P 〉 0.05 ） , they were much lower in laparoscopic group 1 and 4 days after operation compared with those in the open group （ P 〈 0. O1 ）. Conclusions ： Laparoscopic surgery can reduce postoperative HOMA-IR and IR,which tacilitates the postoperative rehabilitation.