胃癌根治术联合改良胃旁路术在胃癌合并2型糖尿病患者中的应用  

Radical Gastrectomy Combined with Modified Gastric Bypass in Treatment of Gastric Cancer Patients with Type2 Diabetes Mellitus

作　　者：焦喜林[1] 王振全[1] 陈金辉[1] 申立中[1] 吴劲松[1] 陈芸[1] 蒋志斌[1] 贺屹巍[1] 苗玲玲[1] 

机构地区：[1]解放军白求恩国际和平医院普外二科,石家庄050082

出　　处：《解放军医药杂志》2015年第9期82-85,共4页Medical & Pharmaceutical Journal of Chinese People’s Liberation Army

摘　　要：目的探讨胃癌根治术联合改良胃旁路术治疗胃癌合并2型糖尿病患者的临床效果。方法回顾性分析我科2007年10月—2014年10月收治的72例胃癌合并2型糖尿病患者的临床资料,根据胃肿瘤部位选择手术方法的不同分为远端胃组30例,近端胃组14例和全胃组28例,分别予远端胃癌根治术、近端胃癌根治术、根治性全胃切除术联合改良式残胃空肠Roux-en-y吻合术。术后观察各组手术并发症,术前及术后1、6个月空腹血糖（FPG）、餐后2 h血糖（2h PG）及糖化血红蛋白（Hb A1C）水平,以及手术后1年癌转移情况。结果本组手术均获成功,术后住院时间9~25 d,进食及营养情况良好,术后恢复顺利。术后无严重手术并发症发生。术后1个月、6个月3组FPG、2h PG及Hb A1c均明显下降（P〈0.01或P〈0.05）。术后1年各组无死亡病例,远端胃组发生肝脏转移2例,近端胃组发生肝脏转移、肺转移各1例,全胃组发生腹腔转移2例、肝脏转移1例。结论胃癌根治术联合改良胃旁路术治疗胃癌合并2型糖尿病患者操作简单,安全可行,有很好的临床应用前景。Objective To investigate the clinical effect of radical gastrectomy combined with modified gastric by-pass in treatment of gastric cancer patients with type 2 diabetes mellitus. Methods Clinical data of 72 gastric cancer pa-tients with type 2 diabetes mellitus during October 2007 and October 2014 was retrospectively analyzed. The 72 patients were divided into distal gastrectomy group （ n=30 ） , proximal gastrectomy group （ n=14 ） and total gastrectomy group （ n=28） according to different operative methods, and the three groups were respectively treated with operations of distal radical gastrectomy, proximal radical gastrectomy and radical total gastrectomy combined with modified Roux-en-Y anas-tomosis of remnant stomach and jejunum. The postoperative complications, fasting plasma glucose （ FBG） levels before and 1 and 6 months after the operation, 2 h postprandial glucose （2hPG） level, glycosylated hemoglobin （HbA1c） level and status of cancer metastasis in postoperative 1 year in the three groups were observed. Results All operations were performed successfully with postoperative 9-25 d of hospital stay, and all patients recovered well with good status of diet and nutrition. No severe postoperative complications were found in all patients. The levels of FBG, 2hPG and HbA1c 1 and 6 months after the operation were significantly decreased in the three groups （P〈0. 01 or P〈0. 05）. With postoper-ative 1 year of follow-up, no death was reported, and there were 2 patients with liver metastasis in distal gastrectomy group, 1 patient with liver metastasis and 1 patient with lung metastasis in proximal gastrectomy group, and 2 patients with abdominal cavity metastasis and 1 patient with liver metastasis in total gastrectomy group. Conclusion The radical gastrectomy combined with modified gastric bypass in treatment of gastric cancer patients with type 2 diabetes mellitus has the advantages such as simple operation and safety.

关 键 词：胃肿瘤 胃旁路术 糖尿病 2型 血糖 

分 类 号：R735.2[医药卫生—肿瘤] R587.1[医药卫生—临床医学]