不同胃癌根治术及Roux-en-Y吻合术式对合并2型糖尿病患者疗效的影响

Influence of different radical gastrectomy and Roux-en-Y anastomosis types on curative effect of type 2 diabetes combined with gastric cancer

目的探讨不同胃癌根治术及Roux-en-Y吻合术对合并胃癌的2型糖尿病(T2DM)患者的治疗效果。方法回顾性分析胃肠外科2009年3月至2011年3月收治的胃癌合并2型糖尿病患者75例行胃癌根治性手术+Roux-en-Y吻合术的临床资料,按照手术方法分为远端胃切除组+改良Roux-en-Y吻合术组(30例),根治性全胃切除术+改良Roux-en-Y吻合术组(25例)以及胃癌根治术(远端/全胃)+常规Roux-en-Y吻合术组(20例)。根据术后1年时糖化血红蛋白水平及药物使用情况进行疗效评估,比较各种手术方式的疗效。结果远端胃癌根治术和根治性全胃切除术(均行改良Roux-en-Y吻合术)一定程度改善胃癌合并T2DM患者术后糖化血红蛋白水平,并对缓解T2DM有一定的疗效,但无统计学差异(P均>0.05)。行改良Roux-en-Y吻合术和常规Roux-en-Y吻合术均可一定程度改善胃癌合并T2DM患者术后糖化血红蛋白水平,并对缓解T2DM有一定的疗效,但无统计学差异(P均>0.05)。结论根治性全胃切除术与远端胃癌根治术行Roux-en-Y吻合术均可降低胃癌合并2型糖尿病患者糖化血红蛋白水平及血糖水平,并对缓解T2DM有一定的疗效,是否保留残胃和Roux-en-Y吻合术中所留Roux肠袢的长短与疗效无明显关系。

Objective To explore the effects of different radical gastrectomy and Roux-en-Y anastomosis types for the treatment of patients with type 2 diabetes （T2DM） combined with gastric cancer. Methods A retrospective analysis was conducted on the clinical data of 75 patients with gastric cancer and T2DM underwent radical gastrectomy plus Roux-en-Y anastomosis in the gastrointestinal surgery from March 2009 to March 2011. According to operation method, the patients were divided into distal gastreetomy plus modified Roux-en-Y anastomosis group （30 cases） , radical total gastrectomy plus modified Roux-en-Y anastomosis group （25 cases）, and the radical gastrectomy （ distaL/total stomach） plus conventional Roux-en-Y anastomosis group （20 cases）. According to glycated hemoglobin （HbA1 c） level at one year after operation and drug use condition, the efficacy evaluation was conducted, and the curative effects between various surgical types were com- pared. Results Either the distal radical gastrectomy or the radical total gastrectomy （ both combined with modified Roux- en-Y anastomosis） and either modified Roux-en-Y anastomosis or conventional Roux-en-Y anastomosis could improve the HbAlc levels to some extent and had a certain efficacy to relieve T2DM ,but their effects had not statistical difference （all P 〉 0.05 ）. Conclusion Both the radical total gastrectomy and distal radical gastrectomy combined with Roux-en-Y anastomosis can reduce HbAlc and blood glucose levels and have a certain efficacy to relieve T2DM in patients with T2DM and gastric cancer. The efficacy is not related to the retention of the remnant stomach and the length of residual Roux loop in Roux-en-Y anastomosis.