Roux-en-Y式胃癌根治术联合胃旁路手术对胃癌并糖尿病患者的治疗作用分析

The therapeutic effect of Roux-en-Y radical gastrectomy combined with gastric bypass surgery on gastric cancer with diabetes mellitus

目的探讨Roux-en-Y式胃癌根治术联合胃旁路手术对胃癌并糖尿病患者的治疗作用。方法将60例胃癌合并2型糖尿病患者,随机分为两组,1组行传统的Roux-en-Y式胃癌根治术,另一组行Roux-en-Y式胃癌根治术联合胃旁路手术,观察两组手术并发症、术后出院时间及术前1天、术后1月患者空腹血糖(FPG),早餐后2h血糖(2hPG),胰岛素抵抗指数(HOMA-IR),体质量变化。结果两组手术均顺利完成,手术后住院时间10~21d,术后饮食过渡良好,恢复顺利,无严重手术并发症发生病例;术后1月与术前1天比较,联合手术组术后FPG、2hPG的下降程度明显优于对照组,联合手术组胰岛素敏感性指数改善更为明显,而患者手术前后体重下降程度无明显差别,生活质量良好。结论 Roux-en-Y式胃癌根治术联合胃旁路手术治疗胃癌并糖尿病患者不增加手术并发症,对胃癌根治范围无影响,且对患者术后糖尿病病情改善明显,是一种针对胃癌合并2型糖尿病患者的更为适合的手术治疗方式。

Objective To investigate the therapeutic effect of Roux-en-Y radical gastrectomy combined with gastric bypass surgery on gastric cancer with diabetes mellitus.Methods Clinical data of 60 gastric cancer patients with type 2 diabetes mellitus was retrospectively analyzed.The patients were randomly divided into two groups,one group received conventional Roux-enY gastric cancer radical operation and the other group Roux-en-Y radical gastrectomy combined with gastric bypass surgery.The postoperative complications,postoperative Length of stay,fasting plasma glucose（FBG）,2 hours postprandial blood glucose（2 hPG）,Insulin resistance index（HOMA-IR）were tested 1 day before operation and 1 month after operation.ResultsThe two groups of operations were performed successfully with postoperative 10-21 dof hospital stay,all patients recovered well with good status of diet.No severe postoperative complications were found in all patients.The FPG,2 hPG of the group with Roux-en-Y Radical Gastrectomy Combined with Gastric Bypass surgery decreased significantly better than the other group form 1 day before operation to 1 month after surgery,also the insulin sensitivity index of the combined operation group was more obvious improvement,while the patients were no significant difference in body weight loss before and after surgery.The quality of life of all the patients is very well.Conclusion The complication of the Roux-en-Y radical gastrectomy combined with gastric bypass surgery does not increase,this combined operation has no effect on the radical area of gastric cancer,and the patient’s diabetes disease improves greatly after the operation.It should to be a more suitable surgical treatment on gastric cancer combined with Type 2 diabetes.