胃癌BillrothⅡ式胃切除术对合并2型糖尿病患者的治疗价值

目的探讨胃癌BillrothⅡ式胃切除术对合并2型糖尿病患者糖代谢的影响。方法回顾性观察7例体重指数（BMl）〈35kg／m^2合并2型糖尿病的病人因胃癌接受Billroth Ⅱ式胃切除手术前后血糖控制情况以及糖尿病治疗的变化。结果7例均成功完成了根治性BillrothⅡ式胃切除术，4例行腹腔镜手术，3例行开腹手术。术后未发生严重并发症。术前空腹血糖（FPG）6．6～9．0mmol／L，平均8．1mmol／L；糖化血红蛋白（HbAlc）6．8％～9．5％，平均7．8％。术后1～8个月复查FPG4．8～7．9mmol／L，平均6．4mmol／L；HbAlc5．5％～7．2％，平均6．3％。据美国糖尿病协会（ADA）糖尿病疗效判断标准，4例治愈，3例改善。结论胃癌BillrothⅡ式胃切除术可治疗胃癌患者合并的2型糖尿病。

Effect of Billroth Ⅱ Gastrectomy on Type 2 Diabetes Mellitus in Patients with Gastric Cancer

Objective To discuss the effect of Billroth Ⅱ gastrcctomy on glucose metabolism in patients with gastric cancer complicated with type 2 diabetes mellitus （T2 DM）. Methods A retrospective study on the serum level of glucose in 7 patients with gastric cancer complicated with T2 DM undergone Billroth Ⅱ gastrectomy. The therapeutic regime for T2 DM after the operation was also analyzed. Results Billroth Ⅱ gastrectomy was completed in all of the 7 patients by open surgery （3） or laparoscopy （4）. No serious intra- and post-operative complications occurred in the series. The preoperative level of fasting plasma glucose （FPG） was between 6.6 and 9.0 mmol/L （ mean 8.1 mmol/L） and glycosylated hemoglobin concentrations （HbAlc） between 6.8% and 9.5% （mean 7.8% ）. While 1 to 8 months after the surgery, the FPG decreased to 4.8 - 7.9 mmol/L （ mean 6.4 mmol/L） and HbAlc 5.5% to 7.2% （mean 6.3% ）. According to the criteria from ADA, 4 patients were cured and 3 were improved. Conclusion Billroth Ⅱ gastrectomy is effective for type 2 diabetes mellitus in patients with gastric cancer.