胃切除后不同消化道重建方式对2型糖尿病患者血糖代谢的影响

目的探讨不同消化道重建方式对2型糖尿病患者胃切除后血糖代谢的影响。方法将2012年3月—2013年3月在该院行根治术的100例胃癌合并2型糖尿病患者按不同消化道重建方式分为BillrothⅠ式组33例,BillrothⅡ式组36例,Roux-en-Y式组31例,综合分析3组患者术前、术后血糖变化。结果 1BillrothⅠ式组患者术后1周、术后1个月、术后6个月的空腹血糖（FBG）及餐后2 h血糖（PG-2h）水平与术前比较差异无统计学意义（P〉0.05）;2BillrothⅡ式组术前及术后1周、1个月、6个月的空腹血糖分别为（8.730±0.859）mmol/L、（7.328±0.706）mmol/L、（6.512±0.714）mmol/L、（6.802±0.813）mmol/L,餐后2 h血糖分别为（11.974±0.918）mmol/L、（7.429±1.432）mmol/L、（7.504±1.019）mmol/L、（7.657±2.033）mmol/L;Roux-enY式组术前及术后1周、1个月、6个月的空腹血糖分别为（8.972±0.843）mmol/L、（7.226±0.516）mmol/L、（6.468±0.533）mmol/L、（6.7042±0.721）mmol/L,餐后2 h血糖分别为（11.938±0.957）mmol/L、（7.024±1.917）mmol/L、（7.382±1.614）mmol/L、（7.665±1.953）mmol/L,BillrothⅡ式组和Roux-en-Y式组术后1周、术后1个月、术后6个月的空腹血糖及餐后2 h血糖水平均明显低于术前（P〈0.05）。结论 BillrothⅡ式手术和Roux-en-Y式手术能够有效改善胃癌合并2型糖尿病患者术后血糖代谢。

Effect of Different Alimentary Reconstruction for Gastrectomy on the Glucose Metabolism in Patients Complicated with Type 2 Diabetes

Objective To investigate the effects of different alimentary reconstruction for gastrectomy on the glucose metabolism in patients complicated with type 2 diabetes. Methods 100 cases who underwent radical surgery for gastric cancer complicated with type 2 diabetes in our hospital from March 2012 to March 2013 were divided into Billroth Ⅰ group （33 cases）, Billreth Ⅱ group（36 cases） and Roux-en-Y group （31 cases） according to different alimentary reconstruction. And the blood glucose levels of three groups before and after operation were analyzed comparatively and comprehensively. Results ①In Billroth I group, there was no significant difference in levels of FBG and PG-2h before operation and 1 week, 1 month, 6 months after operation （P〉0.05）; ②In Billroth Ⅱ group, the levels of FBG before operation, 1 week, 1 month, 6 months after operation were （8.730±0.859）mmol/L, （7.328±0.706）mmol/L, （6.512±0.714）mmol/L, （6.802±0.813）mmol/L, respectively, and the levels of PG-2h before operation, 1 week, 1 month, 6 months after operation were （11.974±0.918）mmol/L, （7.429±1.432）mmol/L, （7.504±1.019）mmol/L, （7.657±2.033）mmol/L, respectively. In Roux-en-Y group, the levels of FBG before operation, 1 week, 1 month, 6 months after operation were （8.972± 0.843）mmol/L, （7.226±0.516）mmol/L, （6.468±0.533）mmol/L, （6.7042±0.721）mmol/L, respectively, and the levels of PG-2h before operation, 1 week, 1 month, 6 months after operation were （11.938±0.957）mmol/L, （7.024±1.917）mmol/L, （7.382±1.614）mmol/L, （7.665±1.953）mmo}/L, respectively. In Billroth Ⅱ group and Roux-en-Y group, the levels of FBG and PG-2h 1 week, 1 month, 6 months after operation were much lower than those before operation （P〈0.05）. Conclusion Billroth Ⅱ or Roux-en-Y type operation can effectively improve the postoperative glucose metabolism of gastrie cancer patients with type 2 diabetes