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目的探讨胃癌根治术联合改良胃旁路术治疗胃癌合并2型糖尿病患者的临床效果。方法回顾性分析我科2007年10月—2014年10月收治的72例胃癌合并2型糖尿病患者的临床资料,根据胃肿瘤部位选择手术方法的不同分为远端胃组30例,近端胃组14例和全胃组28例,分别予远端胃癌根治术、近端胃癌根治术、根治性全胃切除术联合改良式残胃空肠Roux-en-y吻合术。术后观察各组手术并发症,术前及术后1、6个月空腹血糖(FPG)、餐后2 h血糖(2h PG)及糖化血红蛋白(Hb A1C)水平,以及手术后1年癌转移情况。结果本组手术均获成功,术后住院时间9~25 d,进食及营养情况良好,术后恢复顺利。术后无严重手术并发症发生。术后1个月、6个月3组FPG、2h PG及Hb A1c均明显下降(P<0.01或P<0.05)。术后1年各组无死亡病例,远端胃组发生肝脏转移2例,近端胃组发生肝脏转移、肺转移各1例,全胃组发生腹腔转移2例、肝脏转移1例。结论胃癌根治术联合改良胃旁路术治疗胃癌合并2型糖尿病患者操作简单,安全可行,有很好的临床应用前景。
Objective To investigate the clinical efficacy of radical gastrectomy combined with modified gastric bypass in the treatment of patients with gastric cancer complicated with type 2 diabetes mellitus. Methods The clinical data of 72 patients with type 2 diabetes mellitus and gastric cancer admitted to our hospital from October 2007 to October 2014 were retrospectively analyzed. According to the different surgical methods of gastric cancer, 30 patients were divided into distal stomach group, proximal stomach Group 14 cases and total stomach group 28 cases were treated with radical gastrectomy, proximal radical gastrectomy and radical total gastrectomy combined with modified Roux-en-y anastomosis. Postoperative complications were observed and the levels of fasting blood glucose (FPG), 2h postprandial blood glucose (2h PG) and Hb A1C before and after surgery, and 1 year after surgery Happening. Results The operation was successful in this group. The postoperative hospital stay was 9-25 days. The food and nutrition were good and the postoperative recovery was successful. Postoperative no serious complications occurred. The levels of FPG, 2h PG and Hb A1c in 3 months and 6 months after operation were significantly decreased (P <0.01 or P <0.05). One year after operation, there were no death cases in each group, two cases of liver metastasis in distal gastric group, one case of liver metastasis and one case of lung metastasis in proximal gastric group, two cases of abdominal metastasis and one case of liver metastasis. Conclusions Gastric cancer radical resection combined with modified gastric bypass surgery for patients with gastric cancer complicated with type 2 diabetes is simple, safe and feasible, and has good clinical application prospects.