不同胃旁路术对非肥胖型2型糖尿病降糖疗效的观察

目的：探讨不同Roux-en-Y胃旁路术（RYGBP）对非肥胖型2型糖尿病（T2DM）患者降糖效果的影响。方法：回顾性分析2007年6月—2009年12月我院普通外科研究所收治的77例胃癌合并T2DM的非肥胖型患者的临床资料,术中依据肿瘤部位、大小分别行全胃切除RYGBP（37例）、胃大部切除RYGBP（40例）,对术前（0月）、术后1、3、6、12个月空腹血糖（FPG）、OGTT 2小时血糖浓度（2hPG）、空腹胰高血糖素样肽（FGLP-1）水平进行统计分析。结果：全胃切除RYGBP组、胃大部切除RYGBP组术后FPG、2h PG较术前均逐渐降低（P〈0.01）;FGLP-1水平明显升高（P〈0.01）;同一时间点组间对比FPG、2h PG、FGLP-1水平均无统计学差异（P〉0.05）。结论：全胃切除和胃大部切除的RYGBP均对血糖具有控制作用,且保留不同术后胃容积的大小与血糖的控制作用无明显相关。

Observation of the effect of different gastric bypass on non-obese patients with type 2 diabetes mellitus

Objective:To discuss the effect of different Roux-en-Y gastric bypass(RYGBP) on non-obese patients with type 2 diabetes mellitus.Methods:Retrospectively analyze the clinical data of the 77 non-obese patients with type 2 diabetes mellitus and gastric cancer who were underwent Roux-en-Y gastric bypass in the department of general surgery from June 2007 to December 2009.Based on the tumor location,size during the surgery,patients were underwent Roux-en-Y gastric bypass with total gastrectomy(n=37) or subtotal gastrectomy(n=40).The fasting plasma glucose(FPG),OGTT 2h PG,and the free glucagon-like peptide 1(FGLP-1)were analyzed before surgery(0 month) and 1,3,6,12 months after surgery.Results:The fasting plasma glucose and the 2h PG concentrations were significantly decreased after surgery(P<0.01) on the two groups.The free glucagon-like peptide 1 concentrations were significantly increased after surgery(P<0.01).However,no significant differences can be found between the two groups at the same time on the FPG、2h PG and FGLP-1 concentrations(P>0.05).Conclusions:Roux-en-Y gastric bypass with different residual stomach volume can effectively improve glucose metabolism in type 2 diabetic patients,but no significant differences can be found between the two groups on the glucose metabolism,the therapeutic effect of gastric bypass has no obvious contact with the size of residual stomach volume.