不同消化道重建方式对胃癌合并非肥胖型糖尿病患者术后糖代谢的影响

Effect of different digestive tract reconstruction programs on glucose metabolism of non-obese patients with gastric cancer and type 2 diabetes mellitus

目的探讨不同消化道重建方式对胃癌合并非肥胖型糖尿病患者术后糖代谢的影响。方法回顾分析由同一组医师实施手术治疗的胃癌合并非肥胖型糖尿病患者共110例病历资料,按不同的消化道重建方式分为毕Ⅰ组、毕Ⅱ组和Roux-en-Y组,进行术前和术后3个月口服葡萄糖2h血糖(2hPG)、诺和锐和来得时用量、GHbA1C的组内和组间比较。结果组间比较,在2hPG、诺和锐和来得时用量、GHbA1C方面,Roux-en-Y组均比毕Ⅰ组、毕Ⅱ组下降(P<0.05)。组内比较,在2hPG、诺和锐和来得时用量、GHbA1C方面,术后Roux-en-Y组和毕Ⅱ组均较术前下降(P<0.05)。结论毕Ⅱ、Roux-en-Y式吻合重建能改善胃癌合并非肥胖型糖尿病患者术后糖代谢,且Roux-en-Y式优于毕Ⅱ式。

Objective To investigate effect of different digestive tract reconstruction programs on glucose metabolism of non-obese patients with gastric cancer and type 2diabetes mellitus.Methods A total of 110 cases of non-obese patients with gastric cancer and type 2diabetes mellitus were retrospectively analyzed.According to the reconstruction of the digestive tract,the patients were divided into Billroth I group,Billroth II group and Roux-en-Y group.The levels of 2hours postprandial glucose（2hPG）,premixed Insulin Aspart 30 dosage,lantus dosage and hemoglobin A1C（GHbA1C）before surgery and three months after surgery,were compared in the groups.Results The changes of 2hPG,premixed Insulin Aspart 30 dosage,lantus dosage and GHbA1 Cbefore and after surgery decreased statistically in Roux-en-Y group,which compared with Billroth Ⅱgroup and Billroth Ⅰ group（P〈0.05）.There were significant differences in 2hPG,RI2 and GHbA1Cbetween BillrothⅡgroup and Roux-en-Y group（P〈0.05）.Conclusion BillrothⅡ gastrectomy and Roux-en-Y gastrectomy can improve the glucose metabolism of non-obese patients with gastric cancer and type 2diabetes mellitus.Roux-en-Y gastrectomy is more effective than Billroth Ⅱ gastrectomy.