胃癌根治术联合改良胃旁路术对合并2型糖尿病胃癌患者术后血糖的影响

The effect of radical gastrectomy combined with modified gastric by-pass reconstruction on post-operative plasma glucose of gastric cancer patient with type-2 diabetes

目的探讨改良胃旁路术对合并2型糖尿病胃癌患者术后血糖的影响。方法回顾性分析2012年1月至2016年5月在本科室行胃癌根治术联合改良胃旁路术的48例胃癌合并2型糖尿病患者的临床资料。观察患者术前及术后3、6个月空腹血糖、餐后2h血糖、糖化血红蛋白(Hb A1C)水平及BMI的变化。结果所有患者均成功完成手术,患者术后3、6个月的空腹血糖分别为(6.89±1.15)mmol/L和(5.40±0.62)mmol/L,与术前相比,差异均具有统计学意义(P<0.001);患者术后3、6个月的餐后2 h血糖分别为(9.82±1.12)mmol/L和(9.22±1.01)mmol/L,与术前相比差异均具有统计学意义(均P<0.001);患者术后3、6个月的Hb A1C分别为(7.26±0.46)%及(6.8±0.35)%,与术前相比差异均具有统计学意义(均P<0.001);患者术后3、6个月的BMI较术前也有不同程度的下降,差异均具有统计学意义(均P<0.001)。结论胃癌根治术联合改良胃旁路术治疗胃癌合并2型糖尿病的患者安全可行并可以改善患者术后血糖控制。

Objective To investigate the effect of modified gastric by-pass reconstruction on plasma glucose level of gastric cancer patients with type-2 diabetes after surgery. Methods From January 2012 to May 2016, the clinical data of 48 gastric cancer patients with type-2 diabetes who underwent radical gastrec- tomy combined with modified by-pass reconstruction in our department were analyzed retrospectively. Fasting blood glucose, 2h postprandial blood glucose, glycosylated hemoglobin （HbA1C） level and body mass index （BMI） were observed preoperatively, 3- and 6-month postoperatively. Results All operations were success- fully performed. The postoperative average fasting plasma glucose, 2h postprandial plasma glucose and HbAlc at 3- and 6-month was （6.89~1.15） mmol/L and （5.40-＋0.62） retool/L, （9.82-＋1.12） mmol/L and （9.22＋ 1.01 ） mmol/L, （7.26 ＋0.46 ） % and （6.8-＋0.35） % respectively, all statistically different compared with pre- operative results （P〈0.001）. Finally, BMI at postoperative 3- and 6-month were lower than that before surgery （both P〈0.001 ）. Conclusions Radical gastrectomy combined with modified by-pass reconstruction is an effective and safe treatment for gastric cancer patients with type-2 diabetes, which can improve blood glucose control.