不同消化道重建术式对2型糖尿病胃癌患者术后营养状况及血糖的影响

目的：观察远端胃大部切除不同消化道重建术式对2型糖尿病（ type 2 diabetes mellitus ， T2DM）胃癌患者术后营养状况及血糖的影响。方法 T2DM胃癌患者88例行根治性远端胃切除术，其中43例行毕I式重建，22例行毕Ⅱ式重建，23例行Roux-en-Y重建。观察手术前、术后1年3组患者BMI、血清白蛋白、前白蛋白指标，并随访患者糖尿病的控制情况。结果手术前3组患者一般资料及各检测指标差异无统计学意义（ P＞0.05）。术后1年，3组患者BMI、血清白蛋白、前白蛋白均较术前有不同程度的减低，但各组之间指标差异无统计学意义（ P＞0.05）。毕I式组控制血糖的有效率为18.60％，毕Ⅱ式组为72.73％，Roux-en-Y组为73.91％，3组之间差异有统计学意义（χ^2＝17.3903，P＜0.05）。毕Ⅱ式与Roux-en-Y组控制血糖的有效率均高于毕I式组（χ^2＝18.3409，P＜0.05；χ^2＝19.4804，P＜0.05）。毕Ⅱ式与Roux-en-Y组之间则差异无统计学意义（χ^2＝0.0081，P＝0.9284）。结论远端胃大部切除后，毕Ⅱ式与Roux-en-Y重建可改善T2DM胃癌患者血糖代谢，且并不明显影响患者营养状况。

Effects of different gastrointestinal reconstruction methods after distal subtotal gastrectomy on nutritional status and blood glucose in patients with type 2 diabetes and gastric cancer

Objective To observe the effects of different gastrointestinal reconstruction methods after distal subtotal gastrectomy on nutritional condition and blood glucose in patients with type 2 diabetes （ T2DM） and gastric cancer.Methods 88 patients with T2DM and gastric cancer undergoing radial distal gastrectomy were studied and among them 43 patients had Billroth I gastrointestinal reconstruction , 22 patients had Billroth Ⅱ gastrointestinal reconstruction and 23 patients had Roux-en-Y gastrointestinal reconstruction .Body mass index （ BMI） , serum albumin and prealbumin of the 3 groups were measured preoperatively and 1 year after surgery . The patients were followed up .Results There was no significant difference among the 3 groups in preoperative values（P〉0.05）.One year after surgery, BMI, serum albumin and peralbumin in the 3 groups had different degrees of reduction , but showed no statistical difference （ P〉0.05 ） .The effective rate of diabetes control was 18.60%in Billroth I group , 72.73%in Billroth Ⅱ group , and 73.91% in Roux-en-Y group and the difference had statistical significance（χ2 =17.390 3,P〈0.05）.The effective rates of diabetes control in Billroth Ⅱ group and Roux-en-Y group were higher than that in Billroth I group （χ^2 =18.340 9,P〈0.05;χ^2 =19.480 4,P〈0.05）, and there was no evident difference between Billroth Ⅱ group and Roux-en-Y group（χ2 =0.008 1,P=0.928 4）.Conclusion Billroth Ⅱ and Roux-en-Y gastrointestinal reconstruction can improve glycemic metabo-lism of patients with T2DM and gastric cancer without significantly reducing the nutrition status .