不同吻合方式胃转流术对2型糖尿病疗效对比研究

目的 评估不同吻合方式胃转流术对2型糖尿病的临床疗效。方法 2006年6月至2009年2月南京军区福州总医院收治合并2型糖尿病的胃部病变行胃转流术病人61例，按术式分为毕Ⅰ式（n=11）、毕Ⅱ式（n=26）和Roux-en-Y（n=24）吻合3组。统计分析手术前和术后6个月内体质量指数和糖代谢指标变化。结果 术后，Roux-en-Y和毕Ⅱ式组空腹血糖和糖化血红蛋白显著降低、空腹C-肽显著升高、葡萄糖耐量显著改善（P<0.01或P<0.05），且Roux-en-Y组上述指标变化更明显（P<0.01或P<0.05），毕Ⅰ式组未见显著变化（P>0.05）。术后6个月，Roux-en-Y组糖尿病手术总有效率显著高于毕Ⅰ式和毕Ⅱ式组（P<0.01或P<0.05）。结论 Roux-en-Y式胃转流术对2型糖尿病的疗效优于毕Ⅱ式和毕Ⅰ式，并不依赖于体质量的降低，有望成为临床治疗2型糖尿病的有力新手段。

Comparative clinical study of the effects of gastric bypass with different types of anastomosis on type 2 diabetes mellitus

Comparative clinical study of the effects of gastric bypass with different types of anastomosis on type 2 diabetes mellitus        WANG Lie, ZHANG Zai-zhong, HUANG Sheng, et al. Research Institute of General Surgery, Fuzhou General Hospital of Nanjing Military Command, Fuzhou 350025, China
Corresponding author: WANG Yu, E-mail:fzptwk@163.com
Abstract    Objective    To assess the effects of gastric bypass with different types of anastomosis on type 2 diabetes mellitus (T2DM). Methods    From June 2006 to February 2009, 61 patients with gastric lesions combined with type 2 diabetes mellitus performed gastrectomy were prospectively assigned into Billroth Ⅰ group (n=11), Billroth Ⅱ group (n=26) and Roux-en-Y group (n=24) in Fuzhou General Hospital of Nanjing Military Command. The pre- and postoperative clinical parameters associated with glycometabolism and body mass index were measured during a 6-month follow-up period. Results    Fasting blood glucose and glycated hemoglobin levels were significantly decreased after surgery in both Billroth Ⅱ and Roux-en-Y groups (P<0.01 or P<0.05). At 3 and 6 months, patients in both BillrothⅡ and Roux-en-Y groups had significantly increased fasting C-peptide and significant improved oral glucose tolerance test (P<0.01 or P<0.05). The changes of those parameters above in Roux-en-Y group were greater than those in Billroth Ⅱ group(P<0.01 or P<0.05). However, the effects were not shown in Billroth Ⅰ group through the entire follow-up period. T2DM control rate in Roux-en-Y group was higher than that in Billroth Ⅰ and Billroth Ⅱ group (P<0.01 or P<0.05). Conclusion    As compared with Billroth Ⅰ and Billroth Ⅱ reconstruction after gastrectomy, Roux-en-Y gastric bypass seems to be more effective on T2DM control. The therapeutic effect of gastric bypass is independent on loss of body weight. Roux-en-Y gastric bypass may be as a potential management option for T2DM.