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目的探讨胃癌合并糖尿病患者行不同消化道重建手术方式对术后近期和远期血糖变化的影响。方法对合并2型糖尿病的远端胃癌患者69例均行根治性远端胃切除术,其中采用BillrothⅡ式消化道重建术者46例(billrothⅡ式组),BillrothⅠ式消化道重建术者23例(billrothⅠ式组),比较2组术前和术后近期(1个月)、远期(3～6个月)空腹和餐后血糖的变化。结果 69例患者术后近期血糖均升高,胰岛素用量加大,1个月后其空腹和餐后血糖基本恢复至术前水平,BillrothⅡ式组患者术后3,6个月空腹和餐后血糖均明显下降(P<0.05),且餐后血糖下降更明显,与BillrothⅠ式组比较,差异有统计学意义(P<0.05)。结论 BillrothⅡ式消化道重建方式有助于降低胃癌合并糖尿病患者术后空腹和餐后血糖水平,进而影响糖代谢。
Objective To investigate the effect of different methods of gastrointestinal reconstructive surgery on short-term and long-term blood glucose in patients with gastric cancer complicated with diabetes. Methods Sixty-nine patients with distal gastric cancer with type 2 diabetes underwent radical gastrectomy, including 46 patients with Billroth Ⅱ type digestive tract reconstruction (Billroth Ⅱ group) and 23 patients with Billroth Ⅰ type digestive tract reconstruction billroth Ⅰ group). The changes of fasting and postprandial blood glucose before and after surgery (1 month) and long term (3 to 6 months) were compared between the two groups. Results 69 cases of patients with postoperative shortly after the blood sugar were increased, the amount of insulin increased after 1 month of fasting and postprandial blood glucose returned to preoperative levels, Billroth Ⅱ group 3,6 months postoperative fasting and postprandial blood glucose (P <0.05), and the postprandial blood glucose decreased more significantly. Compared with Billroth Ⅰ group, the difference was statistically significant (P <0.05). Conclusions The Billroth Ⅱ digestive tract reconstruction method can help reduce postoperative fasting and postprandial blood glucose levels in patients with gastric cancer complicated with diabetes and thus affect glucose metabolism.