胃大部分切除术后ROUX—en—Y吻合与毕Ⅱ式吻合对非肥胖2型糖尿病患者血糖的影响

目的探讨胃大部分切除术后ROUX—en—Y吻合与毕Ⅱ式吻合对非肥胖2型糖尿病患者血糖的影响。方法选取合并非肥胖2型糖尿病的胃癌行择期胃大部分切除术患者102例，其中56例行ROUX—en—Y吻合，设为ROUX—en—Y吻合组；46例行毕Ⅱ式吻合，设为毕Ⅱ式吻合组。比较两组患者术前、术后1周、术后1个月时空腹血糖（FBG）、矮后两小时血糖（PBG）、空腹糖化血红蛋白（HbAlc）水平，评价术后1个月时临床疗效。结果术前两组患者的FBG、PBG、HbAlc比较．差异均无统计学意义（P〉0．05）；治疗后（术后1周、术后1个月），两组患者的FBG、PBG、HbAlc均不同程度的降低，差异具有统计学意义（P〈0.05或P〈0．01）；除术后1周FBG指标外，ROUX—en—Y吻合组术后1周、术后1个月血糖指标水平均低于毕Ⅱ式吻合组，差异具有统计学意义（P〈0．05）。术后1个月时．ROUX—en—Y吻合组、毕Ⅱ式吻合组中，不需要药物及饮食控制血糖的患者比例分别为69．64％、45．65％，总有效率分别为87．50％、63．04％，差异具有统计学意义（P〈0．05）。结论胃大部分切除术后ROUX—en—Y吻合能够有效降低非肥胖2型糖尿病患者的血糖水平．甚至可以达到长期缓解，且优于毕Ⅱ式吻合术，对胃癌合并2型糖尿病患者的吻合方式的选择具有一定的指导意义。

Influence on blood glucose of ROUX-en-Y anastomosis or Billroth II anastomosis after subtotal gastrectomy in patients with non-obese type 2 diabetes

Objective To explore the influence on blood glucose of ROUX-en-Y anastomosis or Billroth lI anastomosis after subtotal gas- trectomy in patients with non-obese type 2 diabetes. Methods 102 non-obese type 2 diabetes patients underwent subtotal gastrectomy were in- cluded. 56 cases underwent ROUX-en-Y anastomosis, 46 cases underwent Billroth Ⅱ anastomosis. Two groups＇ serum FBG, PBG, HbAlc before op- eration, 1 week and 1 month after operation were compared, and clinical curative effect were evaluated 1 mouth after operation. Results There was no statistical difference on serum FBG, PBG and HbAle before operation in two groups （P〉0.05）. After treatment （1 week and 1 month after opera- tion）, two groups＇ serum FBG, PBG and HbAlc were all decreased （P〈0.05 or P〈0.01）. Except for serum FBG on 1 week after operation, ROUX-en-Y anastomosis group＇ blood glucose on 1 week and 1 month after operation were all lower than that of Billroth Ⅱ anastomosis group （P〈0.05）. 1 month after operation, rate of glycemic control without drug and dietary were 69.64% and 45.65% in ROUX-en-Y anastomosis group and Billroth II anasto- mosis group, and total effective rate were 87.50% and 63.04%, there were statistical differences （P〈0.05）. Conclusion It can effectively reduce non-obese type 2 diabetes patients＂ blood glucose by ROUX-en-Y anastomosis after subtotal gastrectomy, even achieves long-term remission, and better than Billroth Ⅱ anastomosis. It has certain guiding significance on anastomotic mode selection to gastric cancer patients with type 2 diabetes.