远端胃癌不同胃肠道重建方式对合并2型糖尿病患者血糖影响

目的探讨在远端胃癌根治术中,不同消化道重建方式对胃癌合并2型糖尿病患者的术后血糖影响。方法回顾性分析2008年1月至2012年6月期间,胃癌合并2型糖尿病患者102例行胃癌根治性手术的资料,根据手术方式分为BillrothⅠ组18例,BillrothⅡ组21例,RY1组(延长Roux袢胃空肠Roux-en-Y)28例及RY2组(延长胆胰分流袢胃空肠Roux-en-Y组)35例;对比观察术后12个月时患者糖化血红蛋白(Hb A1c)及缓解率。应用SPSS18.0统计软件进行统计分析,Hb A1c计量资料以均数±标准差表示,采用重复测量的方差分析(Bonferroni法);疗效分析多组间比较采用秩和检验(Kruskal-Wallis法),两组间比较采用秩和检验(Mann-Whitney法)。P0.05为有统计学意义,P0.01为有显著统计学意义。结果术后第12个月,只有BillrothⅠ组Hb A1c≥6.5%,与其他3组比较差异均有显著统计学意义(P0.01)。BillrothⅡ组、RY 1组、RY 2组之间术后第12个月Hb A1c水平差异无统计学意义。术后第12个月,在疗效方面,BillrothⅠ组、BillrothⅡ组、RY 1组、RY 2组缓解率分别为44.44%(8/18)、57.14%(12/21)、75%(21/28)、82.86%(29/35),差异有统计学意义(χ2=12.884,P=0.005);将疗效最好的RY2组与其他3组分别进行分析,RY 2组缓解率明显高于Billroth组Ⅰ(Z=-3.359,P=0.001)、BillrothⅡ组(Z=-2.066,P=0.039),差异有统计学意义。结论远端胃癌手术行BillrothⅠ、BillrothⅡ、延长Roux袢胃空肠Roux-en-Y吻合术及延长胆胰分流袢胃空肠Roux-en-Y吻合术均可改善2型糖尿病患者血糖水平。延长胆胰分流袢胃空肠Roux-en-Y吻合术对胃癌合并2型糖尿病患者血糖水平的治疗作用优于BillrothⅠ、BillothⅡ,且对2型糖尿病患者血糖水平改善方面较延长Roux袢胃空肠Roux-en-Y吻合术存在获益趋势。建议对远端胃癌合并2型糖尿病患者选择消化道重建方式时选择延长胆胰分流袢胃空肠Roux-en-Y吻合术。

Blood Glucose Analysis of Patients Combined with Gastric Cancer and Type 2 Diabetes Mellitus Undergoing Distal Gastrectomy with Different Kinds of Gastrointestinal Reconstruction

Objective To investigate the blood glucose analysis of patients combined with gastric cancer and type 2 diabetes mellitus undergoing distal gastrectomy with different kinds of gastrointestinal reconstruction. Methods A retrospective analysis was conducted on the clinical data of 102 patients combined with gastric cancer and type 2 diabetes mellitus who underwent distal gastrectomy from January 2008 to June 2012.All of 102 patients were divided into Billroth Ⅰanastomosis group (18 cases), BillrothⅡ anastomosis group (21 cases), prolonged Roux loop gastrojejunostomy Roux-en-Y anastomosis RY1 group (28 cases), and prolonged biliopancreatic diversion loop gastrojejunostomy Roux-en-Y anastomosis RY2 group (35 cases).Preoperative and 12-month postoperative hemoglobin A1c (HbA1c) levels were analyzed.Statistical analysis was performed by using SPSS 18.0 software.HbA1c level were presented as mean ±SD and examined by variance analysis of repeated measurement ( Bonferroni method ) .Clinical outcome analysis was compared by the Kruskal-Wallis Test and Mann-Whitney Test.A P value of <0.05 was considered as significant difference . Results 12-month after operation, HbA1c of the Billroth Ⅰgroup is≥6.5%, which was significantly different from that of the other three groups (P<0.01).12-month after operation, the remission rate in Billroth Ⅰgroup, Billroth Ⅱgroup, RY 1 group and RY 2 group were 44.44%(8/18)、 57.14%(12/21)、 75%(21/28)、 82.86%(29/35) respectively,with statistically significant difference (χ2 =12.884, P=0.005).The remission rate of the RY2 group was significantly higher than that of Billroth Ⅰ group(Z=-3.359, P=0.001)and also that of Billroth Ⅱ group(Z =-2.066, P=0.039). Conclusion All of Billroth Ⅰ, Billroth Ⅱ, prolonged Roux loop modified gastrojejunostomy Roux-en-Y anastomosis , and prolonged biliopancreatic diversion loop modified gastrojejunostomy Roux-en-Y anastomosis in the distal gastric cancer surgery could improve the blood glucose levels of patients with type 2 diabetes mellitus .Blood glucose control of patients with type 2 diabetes mellitus by using prolonged biliopancreatic diversion loop modified gastrojejunostomy Roux -en-Y anastomosis is better than those of Billroth Ⅰ or Billroth Ⅱanastomosis.Therefore, prolonged biliopancreatic diversion loop modified gastrojejunostomy Roux-en-Y anastomosis is recommended for patients combined with distal gastric cancer and type 2 diabetes mellitus who undergoing distal gastrectomy .