胃大部分切除术后ROUX-en-Y吻合及毕Ⅱ式吻合对2型糖尿病血糖的影响  

Effect of ROUX-en-Y anastomosis and Billroth-II anastomosis after subtotal gastrectomy on blood glucose in type 2 diabetic patients

作　　者：陈开运[1] 向国安[1] 王汉宁[1] 萧金丰[1] 李鹏胜[1] 

机构地区：[1]广东省第二人民医院普外科,广东广州510317

出　　处：《南方医科大学学报》2010年第6期1288-1290,1294,共4页Journal of Southern Medical University

基　　金：广东省科技计划项目(2007B31503002)

摘　　要：目的:研究胃大部分切除手术后进行ROUX-en-Y吻合与毕II式吻合重建对2型糖尿病患者血糖的影响。方法前瞻、非随机对我科2006年1月至2009年12月收治的40例不合并肥胖的胃癌及胃溃疡患者接受ROUX-en-Y吻合重建26例与毕II式吻合重建24例。检测手术前后血糖及糖化血红蛋白(HbA1c)的变化。结果 ROUX-en-Y吻合重建组:空腹血糖在术后1月下降(P<0.05),餐后2h血糖在术后第1周下降(P<0.05),糖化血红蛋白在术后1月下降(P<0.05);毕II式吻合重建组:空腹血糖在术后6月下降(P<0.05),餐后2 h血糖在术后第1月下降(P<0.05),糖化血红蛋白在术后3月下降(P<0.05)。两组相比:术后1月空腹血糖及6月餐后2 h血糖差异有统计学意义(P<0.05),术后3月糖化血红蛋白差异有统计学意义(P<0.05)。结论胃大部分切除手术后进行ROUX-en-Y吻合重建与毕II式吻合重建均能够降低2型糖尿病患者的血糖,但以ROUX-en-Y吻合重建手术效果较为显著。ROUX-en-Y吻合重建术后血糖的下降可能与血中胰高血糖素样肽-1水平升高有关。Objective To evaluate the effect of ROUX-en-Y anastomosis and Billroth-II anastomosis after subtotal gastrectomy on blood glucose in patients with type 2 diabetes.Methods From January 2006 to December 2009,26 and 24 type 2 diabetic patients underwent subtotal gastrectomy for gastric cancer or gastric ulcer and received subsequent ROUX-en-Y anastomosis and Billroth-II anastomosis,respectively.Perioperative and postoperative blood glucose and glycosylated hemoglobin（HbA1c） were detected in these patients to identify the variations.Result In ROUX-en-Y group,the fasting blood glucose（FBG） of the patients decreased significantly in the first month after the operation（t=4.46,P0.05）,and the 2-hour postprandial glucose（2hPG） and HbA1c also underwent significant reductions in the first postoperative week and month,respectively（t=3.5,P0.05;t=2.21,P0.05）.In Billroth-II group,the FBG decreased significantly till 6 months after the operation（t=2.0,P0.05）,and HbA1c reduction occurred 3 months after the operation（t=2.61,P0.05）.There were significant differences in FBG in the first postoperative month,2hPG in the 6th month,and HbA1c in the 3rd month between the two groups（P0.05）.Conclusion The ROUX-en-Y anastomosis and Billroth-II anastomosis after subtotal gastrectomy can both reduce blood glucose of type 2 diabetic patients,but the former approach has better effect.

关 键 词：胃大部分切除术 ROUX-en-Y吻合重建 毕II式吻合重建 2型糖尿病 

分 类 号：R656.61[医药卫生—外科学] R587.1[医药卫生—临床医学]