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目的:探讨胃大部切除后不同吻合术式对胃癌合并2型糖尿病患者血糖的影响。方法:选择66例在本院行手术治疗的胃癌合并2型糖尿病的患者为研究对象,随机分为毕Ⅰ式组26例,毕Ⅱ式组24例,Roux-en-y组16例。检测和比较三组患者术前和术后随访3月时患者的OGTT空腹及负荷后血糖值、糖化血红蛋白等水平。结果:术前三组OGTT空腹血糖、2 h血糖、糖化血红蛋白水平、空腹胰岛素水平、稳态模型评估胰岛素抵抗(HOMA-IR)的比较均无统计学差异(P均>0.05)。术后3月,与毕Ⅰ式组比较,毕Ⅱ式组与Roux-en-y组未达2型糖尿病诊断标准的患者百分率显著升高(X2=7.866,P=0.020),OGTT空腹血糖(F=6.472,P=0.005)水平、OGTT 2 h血糖水平(F=3.431,P=0.041)、糖化血红蛋白水平(F=5.456,P=0.009)、空腹胰岛素水平(F=6.120,P=0.008)、HOMA-IR(F=8.091,P<0.001)均显著降低。毕Ⅱ式组与Roux-en-y组之间以上指标比较均无统计学差异(P>0.05)。结论:胃癌合并2型糖尿病的患者在消化道重建术后部分可得缓解,采用毕Ⅱ式或Roux-en-y吻合术可能更适宜胃癌合并2型糖尿病的患者。
Objective: To investigate the effect of different anastomoses on the blood glucose in patients with gastric cancer complicated with type 2 diabetes after subtotal gastrectomy. Methods: Sixty-six patients with gastric cancer and type 2 diabetes mellitus undergoing surgery in our hospital were selected as study subjects. They were randomly divided into two groups: 26 patients in complete Ⅰ group, 24 patients in complete Ⅱ group and 16 patients in Roux-en-y group. The levels of OGTT fasting and post-loading blood glucose, glycosylated hemoglobin, etc. were measured and compared in three groups before and 3 months after follow-up. Results: There was no significant difference in OGTT fasting blood glucose, 2h blood glucose, glycosylated hemoglobin, fasting insulin, and homeostasis model assessment of insulin resistance (HOMA-IR) among the three groups before operation (all P> 0.05). The percentages of patients who did not meet the diagnostic criteria for type 2 diabetes in group Ⅱ and group Roux-en-y were significantly higher than those in group Ⅱ (χ2 = 7.866, P = 0.020) (F = 6.472, P = 0.005), fasting blood glucose (F = 6.131, P = 0.008) , HOMA-IR (F = 8.091, P <0.001). There was no significant difference in the above indexes between the complete Ⅱ group and the Roux-en-y group (P> 0.05). Conclusions: Patients with gastric cancer with type 2 diabetes mellitus can be partially relieved after digestive reconstruction. Patients with gastric cancer complicated with type 2 diabetes may be more suitable for patients with gastric cancer complicated with type 2 diabetes or Roux-en-y anastomosis.