三角吻合术对胃癌伴T2DM患者全腹腔镜远端胃切除术后糖代谢的影响

Effect of delta-shaped anastomosis in digestive tract reconstruction on glucose metabolism in type 2 diabetic patients following total laparoscopic distal gastrectomy for gastric cancer

目的探讨全腹腔镜远端胃切除术(total laparoscopic distal gastrectomy,TLDG)后行三角吻合消化道重建对胃癌合并2型糖尿病(T2DM)患者糖代谢的影响。方法将90例行TLDG的胃癌伴T2DM患者分为观察组(n=36)与对照组(n=54),观察组行三角吻合术,对照组行Billroth-Ⅰ式吻合。比较两组围手术期情况,术前及术后1、3、6个月测定体质量指数(BMI)、胰岛素用量、空腹血糖(FPG)、餐后2 h血糖(2hPG)、糖化血红蛋白(HbAlc)、血清肿瘤坏死因子α(TNF-α)、白介素-6(IL-6)、网模素-1(omentin-1)、脂联素(adiponectin)、抑胃肽(gastric inhibitory peptide,GIP)、胰高血糖素样肽-1(glucagon-like peptide-1, GLP-1)及GIP/GLP-1。结果观察组的切口长度、手术时间、术中出血量、术后排气时间及住院时间均显著低于对照组(P<0.05)。术后1、3、6个月,观察组的BMI、FPG、2hPG、HbAlc和血清TNF-α、IL-6、GIP、GIP/GLP-1水平均显著低于对照组(P<0.05),而网模素-1、脂联素水平显著高于对照组(P<0.05)。结论胃癌伴T2DM患者行TLDG联合三角吻合消化道重建安全可行,较经典Billroth-Ⅰ式吻合更有利于改善术后糖代谢状态。

Objective To investigate the effect of delta-shaped anastomosis in digestive tract reconstruction on postoperative glucose metabolism in patients with type 2 diabetes mellitus(T2 DM) following total laparoscopic distal gastrectomy(TLDG) for gastric cancer. Methods Ninety patients with T2 DM undergoing TLDG for gastric cancer were divided based on the patients’ preference and surgical indications into delta-shaped anastomosis group(n=36) and Billroth-Ⅰ digestive tract reconstruction group(control group, n=54). The surgical and perioperative data including body mass index(BMI), insulin dosage, fasting plasma glucose(FPG), postprandial 2 h plasma glucose(2 hPG), glycosylated hemoglobin(HbAlc), serum levels of tumor necrosis factor-α(TNF-α), interleukin-6(IL-6), omentin-1, adiponectin, gastric inhibitory peptide(GIP) and glucagon-like peptide-1(GLP-1), and GIP/GLP-1 ratio were compared between the 2 groups before and at 1, 3, and 6 months after the surgery. Results The incision length, operation time, intraoperative blood loss, the time of first bowel movement and hospital stay were significantly shorter or less in delta-shaped anastomosis group than in the control group(P<0.05). At 1, 3 and 6 months after the surgery, BMI, FPG, 2 hPG, HbAlc, serum levels of TNF-α, IL-6 and GIP and GIP/GLP-1 ratio were significantly lower(P<0.05) and the serum levels of omentin-1 and adiponectin were significantly higher in delta-shaped anastomosis group than in the control group(P<0.05). Conclusion In type 2 diabetic patients with gastric cancer, TLDG combined with delta-shaped anastomosis in digestive tract reconstruction is safe and feasible and better improves postoperative glucose metabolism of the patients than classic Billroth-Ⅰ anastomosis.