胃癌合并糖尿病行不同手术方案对术后血糖改变的影响  

Changes on blood glucose of different operation scheme after gastrectomy for gastric cancer in patients complicated with diabetes mellitus

作　　者：苏杰[1] 冯祯声[1] 邱光庭 蔡澄[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普外科,200081

出　　处：《中国综合临床》2013年第5期536-538,共3页Clinical Medicine of China

摘　　要：目的探讨胃癌根治术合并2型糖尿病患者采用不同手术策略对术后血糖变化的影响。方法回顾性分析行胃癌根治性手术的68例胃癌合并2型糖尿病患者术前及术后的血糖变化，按重建方式不同分为3组，毕I式吻合术26例（A组），毕Ⅱ式吻合术22例（B组），Roux-en—Y吻合术20例（c组）。比较3组患者术前及术后1周、1月、6月的空腹血糖水平。结果B、C组患者术后1个月与6个月的血糖水平与术前相比明显好转[（10．03±5．12）、（8．44±5．21）mmol／L与（13．56±3．36）mmol／L；（10．61±3．16）、（7.68±4．88）mmol／L与（12．84±3．36）mmol／L]，且B、C组患者术后1个月与6个月的血糖水平均较A组下降明显[（10．03±5．12）、（8．44±5．21）mmol／L与（11．12±6．32）mmol／L；（10．61±3．16）、（7．68±4．88）mmol／L与（11．12±6．32）mmol／L]（P均〈0．05）。而B、C组之间上述两指标比较差异均无统计学意义（P均〉0．05）。3组患者术后情况，以B、C组患者的糖尿病好转较为明显，其中近50％的患者治愈，血糖控制正常，另一部分除少数无效外，糖尿病药物治疗降级，手术效果显著。结论毕Ⅱ式吻合、Roux-en—Y吻合术对于合并2型糖尿病的胃癌患者具有良好的血糖控制作用，患者术后血糖改变与胃空肠吻合术式有关。Objective To observe the effect of gastrectomy for gastric cancer on blood glucose in patients complicated with type 2 diabetes mellitus by using different operation strategies. Methods The retrospective analysis was carried out of 68 cases who undergone radical surgery for gastric cancer and complicated with type 2 diabetes mellitus. These patients were divided into 3 groups by different kinds of digestive tract reconstruction, Billroth I （n = 26）, Billroth II （ n = 22） and Roux-en-Y （ n = 20）. The levels of fasting blood glucose （FBG） were detected before and after operation one week, one month and six months in three groups. Results Comparing to the level before operation,the level of FBG after operation showed a descent in group B and group C （ （10. 03 ± 5.12 ） vs. （13.56 ±3.36） mmol/L;（8.44±5.21） vs. （13.56 ±3.36） mmol/L; （10. 61±3.16） vs. （12.84 ±3.36） and（7.68 ±4.88） vs. （12.84 ±3.36） mmol/L）which was better than group A（（10.03 ±5.12）vs. （11.12 ±6.32）,（8.44±5.21） vs. （11.12 ±6.32） mmol/L; （10.61 ±3.16） vs. （11.12±6.32） mmol/L） , （ 7. 68 ± 4. 88 ） vs. （11.12±6.32） mmolfL;P〈O. O5,but there was no significantly difference between B and group C （ P 〉 0. 05 ）. The 3 groups of patients, with B, C groups of patients with diabetes improved obviously, of which nearly 50% of patients cured, normal blood sugar control, the other part with the exception of a few effective, degradation of diabetes drug treatment, and operation effect was significant. Conclusion It is effective to control the blood glucose of gastric cancer patients complicated with type 2 diabetes with Billroth II or Roux-en-Y gastrectomy. There is a correlation between postoperative blood glucose change and different gastrojejunal anastomosis.

关 键 词：胃癌 糖尿病 

分 类 号：R587.1[医药卫生—内分泌]