【摘要】 目的探讨腹腔镜胃切除术后不同消化道重建方式对合并2型糖尿病胃癌患者血糖的影响。方法回顾性分析87例胃癌合并2型糖尿病患者接受不同消化道重建术前后空腹血糖及体重的变化情况。其中胃远端大部切除术后毕Ⅰ式吻合31例(A组),胃远端大部切除术后毕Ⅱ式吻合27例(B组),全胃切除术后行食道空肠Roux-en-Y吻合重建者29例(C组)。结果 A组手术前后空腹血糖水平差异无统计学意义(P>0.05);B、C组术后1个月起空腹血糖水平与术前比较明显降低,差异有统计学意义(P<0.05);而且A组与B组之间、A组与C组之间术后1个月起空腹血糖水平与术前比较,差异有统计学意义(P<0.05),B组与C组之间差异无统计学意义(P>0.05);至术后6个月时,B组有16例(59.2%)患者停用口服降糖药物或注射用胰岛素,7例(25.9%)患者减少口服降糖药物及注射胰岛素用量,总有效率85.1%;C组有17例(58.6%)患者停用药物或胰岛素,8例(27.5%)患者减少药物或胰岛素用量,血糖控制总有效率86.1%;A组病例无药物及胰岛素剂量调整。3组手术前后体重水平比较差异均有统计学意义(P<0.05),但3组之间两两比较术后1个月起体重水平与术前的变化比较差异无统计学意义(P>0.05)。结论胃远端大部切除术后毕Ⅱ式吻合重建及全胃切除术后食管空肠Rouxen-Y吻合重建对胃癌患者合并的2型糖尿病有明显治疗作用,而且术后1个月即显效,并与体重下降无关。更多还原

【Abstract】 Objective To investigate the influence of alimentary tract reconstruction after laparoscopic gastrectomy on the blood glucose level in gastric cancer patients complicated with type 2 diabetes mellitus(T2DM).Methods The blood glucose and body weight before operation,and 1 month,3 months and 6 months after operation in 87 gastric cancer patients complicated with T2DM were retrospectively analyzed.These patients underwent different alimentary tract reconstructions,including 31 patients for Billroth Ⅰ after distal subtotal gastrectomy(Group A),27 for Billroth Ⅱ after distal subtotal gastrectomy(Group B),and 29 for esophageal Roux-en-Y jejunostomy after total gastrectomy(Group C).Results There was no significant change in blood glucose in Group A(P>0.05),while there were significant reduction in blood glucose in both Group B and C since 1 month after surgery(P<0.05).Moreover,the reductions of blood glucose in Group B or C were significantly more prominent than those in Group A since 1 month after surgery(P<0.05),though there was no significant difference between Group B and C(P>0.05).Until 6 months after operation,16 patients(59.2%) in Group B and 17 patients(58.6%) in Group C were free of oral hypoglycemic drugs or insulin dependence;7 patients(25.9%) in Group B and 8 patients(27.5%) in Group C required less oral hypoglycemic drugs or insulin dosage.The total effective rates in Group B and C were 85.1% and 86.1%,respectively.However,no dose adjustment was required in Group A.Significant changes of body weight were revealed in all the 3 groups after operation(P<0.05),though there was no significant difference observed in body weight reduction among the 3 groups(P>0.05).Conclusion Billroth Ⅱ after distal subtotal gastrectomy and esophageal Roux-en-Y jejunostomy after total gastrectomy alleviate blood glucose level in gastric cancer patients complicated with T2DM,which has nothing to do with weight loss.更多还原