胃大部切除后不同吻合术式对胃癌合并2型糖尿病患者血糖的影响  

Impact on Different Types of Gastrectomy Reconstruction of Patients with Gastric Cancer and Type 2 Diabetes

作　　者：苏杰[1] 吕凯荧[1] 冯祯声[1] 王鑫瑜[1] 高勤革[1] 

机构地区：[1]上海交通大学附属第一人民医院分院,上海200081

出　　处：《现代生物医学进展》2013年第8期1481-1483,共3页Progress in Modern Biomedicine

摘　　要：目的:探讨胃大部切除后不同吻合术式对胃癌合并2型糖尿病患者血糖的影响。方法:选择66例在本院行手术治疗的胃癌合并2型糖尿病的患者为研究对象,随机分为毕Ⅰ式组26例,毕Ⅱ式组24例,Roux-en-y组16例。检测和比较三组患者术前和术后随访3月时患者的OGTT空腹及负荷后血糖值、糖化血红蛋白等水平。结果:术前三组OGTT空腹血糖、2 h血糖、糖化血红蛋白水平、空腹胰岛素水平、稳态模型评估胰岛素抵抗(HOMA-IR)的比较均无统计学差异(P均>0.05)。术后3月,与毕Ⅰ式组比较,毕Ⅱ式组与Roux-en-y组未达2型糖尿病诊断标准的患者百分率显著升高(X2=7.866,P=0.020),OGTT空腹血糖(F=6.472,P=0.005)水平、OGTT 2 h血糖水平(F=3.431,P=0.041)、糖化血红蛋白水平(F=5.456,P=0.009)、空腹胰岛素水平(F=6.120,P=0.008)、HOMA-IR(F=8.091,P<0.001)均显著降低。毕Ⅱ式组与Roux-en-y组之间以上指标比较均无统计学差异(P>0.05)。结论:胃癌合并2型糖尿病的患者在消化道重建术后部分可得缓解,采用毕Ⅱ式或Roux-en-y吻合术可能更适宜胃癌合并2型糖尿病的患者。Objective： To investigate the impact of different type of gastrectomy reconstruction on patients with gastric cancer and type 2 diabetes. Methods： 66 cases of gastric cancer and types 2 diabetes who were undergoing surgical treatment in our hospital were collected and divided into Billroth I group of 26 cases, Billroth II group of 24 cases and Roux-en-y group of 16 cases. Their preoperative clinical data and follow-up after 3 months data were collected and compared. OGTT fasting, challenged blood glucose levels and glycosylated hemoglobin were tested. Results： There was no significant difference of OGTT fasting plasma glucose and challenged glucose after 2 hours, glycosylated hemoglobin, fasting insulin and HOMA-IR was found （P〉0.05） before surgery, After three-months＇ follow-up, the number of cases under diabetes standards was significantly increased （X2 =7.866, P =0.020） in the Billroth II group and Roux-en-y group compared with Billroth I group. The OGTT fasting glucose （F = 6.472, P = 0.005）, OGTT 2 h glucose value （F = 3.431, P = 0.041）, glycosylated hemoglobin （F = 5.456, P = 0.009）, fasting insulin （F=6.120, P=0.008） and HOMA-IR（F=8.091, P〈0.001） were significantly lower. Above indicators between the Roux-en-y group and Billroth II group had no significant difference （P〉 0.05）. Conclusion： Some of the patients with gastric cancer and diabetes mellitus in the digestive tract reconstruction could be alleviated. Billroth II or Roux-en-y anastomosis for gastric cancer patients with diabetes mellitus may be more suitable.

关 键 词：2型糖尿病 胃癌 胃大部切除术 血糖 糖化血红蛋白 

分 类 号：R735.5[医药卫生—肿瘤] R587.1[医药卫生—临床医学]