Roux-en-Y吻合重建对胃窦癌合并T2DM患者血糖及胰岛功能的影响

Effect of blood glucose and islet function of Roux-en-Y anastomosis on gastric cancer combined T2DM

目的:探讨Roux-en-Y吻合重建术对胃窦癌合并2型糖尿病(T2DM)患者血糖水平、胰岛功能及术后生存质量的影响。方法:选取2010年1月—2014年1月收治的68例I^II期胃窦癌合并T2DM患者为研究对象,根据患者手术方式将其分为胃十二指肠吻合组(对照组)32例,Roux-en-Y吻合重建组(观察组)36例,对比分析2组患者术前、术后6个月体质量指数(BMI)、空腹血糖(FPG)、糖化血红蛋白(Hb A1c)、空腹胰岛素(FINS)、空腹C肽(FCP)水平。术前、术后6个月对2组患者行口服葡萄糖耐量试验(OGTT),检测及比较2组餐后2h血糖(2h FPG)、餐后2 h胰岛素(2h INS)及餐后2 h C肽(2h CP),计算2组胰岛素抵抗指数(HOMA-IR)。术前及术后6个月采用肿瘤生存质量量表(QOL)对2组患者生存质量进行评价。结果:对照组术后6个月BMI、FPG、Hb A1c、FINS、FCP、2h FPG、2h INS、2h CP、HOMA-IR与术前相比差异无统计学意义(P>0.05)。观察组术后6个月FPG、Hb A1c、2h FPG、HOMA-IR水平显著低于术前,而FINS、FCP、2h INS、2h CP较术前显著升高(P<0.05)。术后6个月观察组食欲、睡眠、自理能力、心理能力、疾病认识以及总生存质量评分均高于对照组(P<0.05)。结论:Roux-en-Y吻合术能有效提高胃窦癌合并T2DM患者胰岛β细胞功能,降低血糖水平,提高患者生存质量。

Objective：To investigate the effects of blood glucose levels,insulin function and quality of life after surgery of Roux-en-Y gastric anastomosis reconstruction of type 2 diabetes mellitus（T2DM）.Methods：68 cases of stage Ⅰ-Ⅱ patients with gastric cancer combined T2DM period were divided into esophag ogastric anastomosis group （control group,n=32）,Roux-en-Y anastomosis surgery group（observation group,n=36） from January 2010 to January 2014.The body mass index（BMI）,the levels of fasting blood glucose（FPG）,glycated hemoglobin（HbA1c）,fasting insulin（FINS）,fasting C-peptide（FCP）,2 h postprandial blood glucose（2hFPG）,2 h postprandial insulin （2hlNS） and postprandial 2hC peptide （2hCP）,insulin resistance index calculation two groups （HOMA-IR） of two groups were comparated.The quality of life of patients of Preoperative and postoperative 6 months were evaluated with Quality of Life（QOL） scale.Results：The levels of BMI,FPG,HbA1c,FINS,FCP,2hFPG,2hlNS,2hCP of control group before pre-surgery were lower than observation group（P＞0.05）.The levels of FPG,HbA1c,2hFPG,HOMA-IR of observation group after six months were significantly lower than before surgery,and the levels of FINS,FCP,2hlNS,2hCP after six months were higher than before surgery（P＜ 0.05）.The appetite,sleep,self-care ability,mental ability,disease awareness and overall quality of life scores of observation group were higher than control group,the difference was statistically significant（P＜ 0.05）.Conclusion：Roux-en-Y gastric anastomosis can improve islet β cells in patients with combined T2DM function,lower blood sugar levels,improve the quality of life of patients.