不同消化道重建方案对并发2型糖尿病胃癌患者术后糖代谢的影响

Effect of Different Digestive Tract Reconstruction Programs on T2DM Gastric Cancer Patients with Glucose Metabolism

目的探讨胃癌根治术后3种不同消化道重建术式对胃癌同时合并2型糖尿病患者术后糖代谢的影响。方法回顾性分析2010年10月-2012年10月行胃癌根治消化道重建的64例胃癌合并2型糖尿病患者的病例资料。根据消化道重建方式的不同把患者分为3组,A组26例行BillrothⅠ式吻合术,B组22例行BillrothⅡ式吻合术,C组16例行Roux-en-Y式吻合术。比较3组患者术前及术后近期(1个月)、短期(3个月)、远期(6个月)的体重、空腹血糖(FPG)、餐后2 h血糖(2 h PG)及胰岛素用量情况。结果 3组患者术前体重、血糖及胰岛素用量差异均无统计学意义(P>0.05);而术后随访发现,消化道重建术后3组患者体重、血糖和胰岛素用量均有明显下降(P<0.05),B组、C组在术后所选时间内比A组下降更为显著(P<0.05);而B组,C组比较差异无统计学意义(P>0.05)。术后6个月3组控制血糖的有效率分别为A组15.3%、B组81.8%、C组81.3%。结论 3种消化道重建术对2型糖尿病均有一定治疗效果,且BillrothⅡ式或Roux-en-Y式疗效优于BillrothⅠ式,BillrothⅡ式与Roux-en-Y式疗效差异无统计学意义。

Objective To observe the effect of different digestive tract reconstruction programs on T2 DM gastric cancer patients with glucose metabolism. Methods A retrospective analysis of 64 cases of gastric cancer patients with type 2 diabetes and gastric digestive tract reconstructions were conducted,depending on the reconstruction of the digestive tract,the patients were divided into 3 groups,BillrothⅠ anastomosis 26 cases( group A),BillrothⅡ anastomosis 22 cases( group B),Roux-en-Y anastomosis 16 cases( group C). Recent( 1 month),short-term( 3 months) and long-term( 6 months) body weight,fasting blood glucose( FBG),postprandial 2 h plasma glucose( 2 h PG) and insulin dosage case of the 3 groups before and after surgery were compared. Results There had no significant difference of the 3 groups of in preoperative body weight,blood glucose and insulin dosage( P > 0. 05); The postoperative follow-up found that body weight,blood glucose and insulin dosage reconstruction of the 3groups after surgery significantly decreased( P < 0. 05),and group B and C had more significant decrease than group A( P <0. 05); there had no significant difference between group B and C( P > 0. 05). Glycemic control rates were group A 15. 3%,group B 81. 8%,group C 81. 3%. Conclusion 3 digestive tract reconstruction for type 2 diabetes have a certain effect,and Billroth Ⅱtype or Roux-en-Y type are more effective than Billroth Ⅰ type,the difference of Billroth Ⅱ style and Roux-en-Y-type have no statistically significance.