不同消化道重建方式对远端胃癌合并2型糖尿病患者术后血糖的影响

The Effect on Blood Glucose of Different Alimentary Reconstruction after Radical Surgery for Patients with Gastric Cancer complicated Type 2 Diabetes

目的:探讨不同消化道重建方式对远端胃癌合并2型糖尿病患者术后血糖的影响。方法:选取本院79例远端胃癌合并2型糖尿病的患者,对其行根治性远端胃大部切除术,按消化道重建方式的不同分为三组,A组19例:毕Ⅰ式吻合;B组38例:单纯毕Ⅱ式吻合;C组22例:毕Ⅱ式吻合+空肠侧侧吻合。比较三组患者术后血糖的变化情况。结果:A组血糖治疗有效率为26.3%,B组为81.6%,C组为86.4%。B、C组术后对血糖控制的有效率均高于A组(P<0.05),而B、C组之间比较差异无统计学意义(P>0.05)。B、C组术后1、6、12个月的FPG、2 h PG、Hb Alc与A组比较差异均有统计学意义(P<0.05);而B、C组之间比较差异无统计学意义(P>0.05)。结论:毕Ⅱ式吻合能够有效控制术后的血糖,并推测前肠短路导致肠激素分泌减少可能是手术治疗糖尿病的主要原因。

Objective：To observe the effect on blood glucose of different digestive tract reconstruction after radical surgery for patients with gastric cancer complicated type 2 diabetes.Method：79 cases of gastric cancer complicated with type 2 diabetes were selected in our hospital,the most radical distal gastric resection was used for them, and the patients were divided into 3 groups by different kinds of digestive tract reconstruction, the group A：Billroth I, the group B：only Billroth Ⅱ, the group C： Billroth Ⅱ ＋Braun, and their blood glucose were analyzed.Result：The effect rates of blood glucose control after operation of the group A was 26.3%, the group B was 81.6%, the group C was 86.4%. The effect rates of the group B and C were higher than the group A（P〈0.05）.There was no significant difference between the group B and C（P〈0.05）. After operation for one month, six months and twelve months, the FPG, 2 h PG, Hb Alc of the group B and C compared with the group A,the differences were statistically significant（P〈0.05）. There was no significant difference between the group B and C（P〉0.05）.Conclusion：It is effective for controlling the blood glucose of gastric cancer patients complicated with type 2 diabetes with Billroth Ⅱ after radica I surgery, and the reason may be the induce of intestines hormone after bypass in former intestines.