胃癌根治术联合改良胃转流手术治疗胃癌合并2型糖尿病的研究  

Study on Radical Gastrectomy Combined with Gastric Bypass Operation in the Treatment of Gastric Cancer Patients with Type II Diabetes

作　　者：刘涛[1] 谢光伟[1] 田庆忠[1] 李进[1] 

机构地区：[1]东南大学附属徐州医院(徐州市中心医院)肿瘤外科,江苏徐州221009

出　　处：《中外医疗》2013年第35期5-7,12,共4页China & Foreign Medical Treatment

摘　　要：目的探讨胃癌根治术联合改良胃转流手术治疗胃癌合并2型糖尿病的临床疗效。方法以30例胃癌且合并肥胖2型糖尿病患者作为研究对象,BMI>28 kg/m2,分别行根治性全胃切除+空肠食管Roux-en-y吻合术(两"Y"型肠袢的长度分别为100 cm)13例或根治性远端胃次全切除+胃空肠Roux-en-y吻合术(如前)17例(A组),回顾性分析该院2005年1月—2012年7月收治的63例胃癌合并糖尿病患者手术对糖尿病的影响,其中胃癌根治术行毕I式吻合手术21例(B组),胃癌根治术行传统Rou-en-Y吻合(两"Y"型肠袢的长度分别为15、50 cm),BMI>28 kg/m225例(C组),BMI<28 kg/m217例(D组)。观察患者术前及术后体重指数(BMI),空腹血糖(FBG),餐后2 h血糖(2 hPBG),C肽(C-P)及糖化血红蛋白(HbAIC)的变化情况。结果 A和D组术后6、12个月BMI、FBG、2 h PBG、C-P及HbAIC较术前明显降低。B术后6、12个月BMI、FBG、2 h PBG、C-P及HbAIC均较术前无明显降低,C组术后6、12个月BMI、FBG、2 hPBG、C-P及HbAIC均较术前有降低,但差异无统计学意义,A较C组术后有明显降低,差异有统计学意义。结论胃癌根治术联合改良胃转流手术治疗胃癌合并肥胖2型糖尿病很好的临床应用前景,其机制有待进一步研究。Objective To investigate the clinic effects of radical gastrectomy combined with modified gastric bypass operation in the treatment of gastric cancer patients complicated with type 2 diabetes. Methods Thirty patients suffering from gastric cancer complicated with obesity（BMI〉28 kg/m^2）, type 2 diabetes mellitus underwent gastric cancer radical excision and modified gastric- bowel bypass（group A）, （two ＂Y＂ type, respectively, the length of the bowel to 100cm）. Sixty- three patients suffering from gastric cancer complicated with type 2 diabetes mellitus in Xuzhou Central Hospital from January, 2005 to July, 2012 were detected for surgery on the impact of diabetes, in which 21 cases underwent radical gastrectomy and Billroth I anastomosis （B group）, 25 cases radical gastrectomy and traditionally Rou-en-Y （two ＂Y＂ type of bowel lengths respectively 15,50 cm）, BMI〉 28kg/m^2 （group C）, 17 cases BMI 〈28 kg/m2 （group D）. The changes of body mass index （BMI）, fasting blood glucose （FBG）, 2-hour postprandial blood glucose （2hPBG）, C peptide （C-P） and glycosylated hemoglabin（HbAIC） of the patients before the operation, six months and twelve months after the operation were observed. Results 6 and 12 months after the operation, BMI, FBG, 2 h PBG, C-P and HbAIC in Group A and group D were significantly lower than those before the operation, but in Group B no significant differences, in Group C, BMI, FBG, 2 h PBG, C-P and HbAIC decreased than those preoperative, but no significant difference. BMI, FBG, 2h PBG, C- P and HbAIC in Group A were significantly lower than Group C after the operation with statistical significance. Conclusion Radi- cal gastrectomy combined with modified gastric bypass surgery for patients with gastric cancer complicated by obesity and type I1 diabetes have good prospects of clinical application, and the mechanism needs further study.

关 键 词：胃癌 糖尿病 胃转流术 

分 类 号：R656.6[医药卫生—外科学]