胃大部切除术后不同消化道重建对T2DM患者血糖的影响及机制研究  

The influence of different digestive tract reconstruction methods on blood sugar of T2DM patients after subtotal gastrectomy

作　　者：金育德[1] 戴闯[1] 朱炜[2] 俞宏斌[1] 徐永强[1] 王宗立[1] Jin Yude, Dai Chuang, Zhu Wei, Yu Hongbin, Xu Yongqiang, Wang Zongli Department of Gastrointestinal Surgery, Hazhou First People＇s Hospital, Huzhou 313000, China(Jin Y D, Dai C, Yu HB, Xu Y Q, Wang ZL ）; Department of Oncology, Httzhou First People＇s Hospital, Huzhou 313000, China （ Zhu W)

机构地区：[1]浙江省湖州市第一人民医院胃肠外利,湖州313000 [2]浙江省湖州市第一人民医院肿瘤外科,湖州313000

出　　处：《中华内分泌外科杂志》2017年第6期463-466,475,共5页Chinese Journal of Endocrine Surgery

摘　　要：目的分析胃大部切除术后不同消化道重建对T2DM患者血糖的影响，探讨可能的作用机制。方法回顾性分析64例因胃溃疡或胃癌需行胃大部切除术的T2DM患者临床资料，根据消化道重建方式的不同分为RoUx-en-Y组（34例）毕II式组（30例），胃大部切除术后分别采用Roux-en-Y吻合和毕II式吻合的消化道重建方式，术后随访6个月，比较术前、术后1周、术后1个月、术后3个月和术后6个月2组BMI、空腹血糖、餐后2h血糖、糖化血红蛋白、空腹胰岛素、胰岛素抵抗指数（HOMA-IR）、胰高血糖素样肽-1（GLP-1）和抑胃肽（GIP）、GIP／GLP．1的变化和差异。结果与术前比较，2组术后3个月、6个月BMI显著降低（P〈0．05），2组间相同时间点比较差异无统计学意义（P〉0．05）；与术前比较，2组术后1周、1个月、3个月、6个月空腹血糖、餐后2h血糖、糖化血红蛋白、空腹胰岛素和HOMA-IR显著降低，且相同时间点比较Roux-en-Y组空腹血糖、餐后2h血糖低于毕II式组（P〈0．05），术后3个月、6个月Roux-en-Y组糖化血红蛋白低于毕II式组（P〈0．05）。与术前比较，2组术后l周、1个月、3个月、6个月GIP、GIP／GLP．1显著降低，且相同时间点比较Roux-en-Y组GIP、GIP／GLP-1低于毕II式组（P〈0．05）。结论胃大部切除术后采用Roux-en-Y吻合的消化道重建方式更有利于降低T2DM患者血糖，可能与此种术式更有利于维持肠．胰岛轴平衡有关。Objective To analyze the influence of different digestive tract reconstruction methods on blood sugar in T2DM patients after subtotal gastrectomy, and to explore the possible mechanism. Methods The clinical data of 64 cases of T2DM patients undergoing subtotal gastrectomy because of gastric ulcer or cancer were retrospectively analyzed. They were divided into Roux-en-Y group （34 cases） and Billroth I! group （30 cases） according to the different reconstruction methods of digestive tract, and they were treated by Roux-en-Y anasto- mosis and Billroth II anastomosis respectively after subtotal gastrectomy. They were followed up for 6 months. BMI, fasting blood sugar, 2 h postprandial blood glucose, glycosylated hemoglobin, fasting insulin, insulin resis- tance index （HOMA-IR）, glucagon peptide 1 （GLP-1）, gastric inhibitory peptides （GIP）, and GIP/GLP-1 before surgery and one week, one month, 3 months, and 6 months after surgery were compared between the two groups. Results BMI of the two groups 3 months, and 6 months after surgery was significantly lower than those before surgery （P〈0.05）, and it had no statistical significance between the two groups at the same time point （P〉0.05）. Compared with preoperative, the fasting blood sugar, 2 h postprandial blood glucose, glycosylated hemoglobin, fasting insulin, HOMA-IR one week, one month, 3 months, and 6 months after surgery in the two groups were significantly lower than those before surgery （P〈0.05）. The fasting blood sugar, and 2 h postprandial blood glucose were lower in Roux-en-Y group than in Billroth II group （P〈0.05）. The glycosylated hemoglobin in Roux-en-Y group was lower than those in Billroth II group at 3 months, and 6 months after surgery （P〈O.05）. Compared with those before surgery, GIP and GIP/GLP-1 in the two groups at one week, one month, 3 months, and 6 months were significantly decreased after operation （P〈0.05）. Also, they were significantly lower in Roux-en-Y group compared with Billroth II gr

关 键 词：胃大部切除术 消化道重建 2型糖尿病 血糖 

分 类 号：R587.1[医药卫生—内分泌] R656.61[医药卫生—内科学]