胃切除术后不同消化道重建方式对2型糖尿病患者治疗效果的临床回顾性研究

目的探讨胃切除术后不同消化道重建方式对2型糖尿病（NIDDM）患者治疗效果的影响。方法回顾性分析我科2005年1月至2008年1月收治的24例不合并肥胖NIDDM的胃癌及壶腹周围癌患者接受不同消化道重建术前后血糖及胰岛素用量的变化情况，其中毕1式胃肠吻合8例（BI组）；Whipple术组10例；全胃切除、食道空肠Roux-en-y吻合组6例。结果BI组手术前后血糖平均水平变化差异无统计学意义（P〉0．05）；Whipple组、全胃组术后1、2个月起血糖平均水平与术前比较差异有统计学意义（P〈0．001）；BI组5例术前应用胰岛素，2例术后胰岛素用量不变，2例增量，1例减量；whipple组6例术前应用胰岛素，2例术后停用胰岛素，4例减量；全胃组4例术前应用胰岛素，2例术后停用胰岛素，2例减量。结论全胃切除及Whipple术降低了不合并肥胖NIDDM患者的血糖水平及胰岛素用量。胃切除术后消化道雷律治疗对不合并肥胖NIDDM的效果县肯定的。

Retrospective study of the effect of alimentary tract reconstruction after gastrectomy on the treatment of type 2 diabetes mellitus

Objective To research the effect of alimentary tract reconstruction after gastrectomy on the treatment of type 2 diabetes mellitus(non-insulin-dependent diabetes mellitus, NIDDM). Methods From January 2005 to January 2008, perioperative blood glucose level and insulin therapy in 24 gastric cancer or periampullary carcinoma patients with non-obesity type 2 diabetes were retrospectively analyzed. These patients underwent different alimentary tract reconstruction, including 8 patients for Billroth I, 10 for standard Whipples operation, 6 for esophageal Roux-en-Y jejunostomy after total gastrectomy. Glucose level and insulin dosage of thease patients were compared. Results In the patients underwent Billroth I operation, change of blood glucose level before and after operation was not significant(P＞0.05). The level of blood glucose in patients underwent Whipples operation and total gastrectomy were significant changed 1 and 2 months after the operation (P<0.001). In Billroth I group, 5 patients used insulin to control hyperglycemia preoperatively. After the operation, 2 patents maintained preoperative insulin dosage, 2 had to increase the use of insulin and 1 decreased the insulin dosage. In Whipples group, 6 patients used insulin preoperatively. Interestingly, 4 patents needed less insulin to control hyperglycemia and 2 were free of insulin dependance. In total gastrectomy group, there were 4 patients using insulin to control hyperglycemia. After the operation, 2 patents needed less insulin dosage and 2 stopped using insulin. Conclusions Both Whipples operation and total gastrectomy lead to decreased blood glucose level in NIDDM patients and less need of insulin.The effect of some types of alimentary tract reconstruction after gastrectomy on treatment of type 2 diabetes mellitus is assertive.