3种消化道重建对胃癌合并2型糖尿病患者血糖及并发症的影响

Effect of three kinds of digestive tract reconstruction on postoperative blood glucose and complications in patients with gastric cancer complicated with type 2 diabetes

摘要:

目的：观察3种不同消化道重建方式对胃癌合并2型糖尿病患者术后血糖的影响及并发症的发生情况。方法：回顾性分析2003年1月至2012年10月本院收治的47例行开腹胃癌根治术的胃癌合并2型糖尿病患者的临床资料；分别记录并比较毕Ⅰ（A组，12例）、毕Ⅱ（B组，20例）、Roux-en-Y 吻合术（C组，15例）3组患者术前、术后1周、术后2周、术后1个月、术后3个月的空腹血糖（fasting plasma glucose，FPG）及餐后2 h血糖（2-hour post-meal blood glucose，2hPG）水平，同时观察患者住院期间术后并发症的发生情况。结果：与术前相比，术后2周、1月、3月与术前FPG比较，差异均有统计学意义（P＜0.001）；术后1周、2周、1月、3月与术前2hPG比较，差异均有统计学意义（P＜0.01）；3组患者术后3个月糖尿病改善的有效率分别为30.00%、77.78%、84.62%。3组患者术后并发症的发生率分别为41.67%、50.00%、33.33%；总体并发症的发生率为42.55%，其中肺部感染以发生率为19.15%居于首位。结论：毕Ⅱ与Roux-en-Y 吻合术对胃癌合并2 型糖尿病患者的血糖改善作用优于毕Ⅰ吻合术，其中以Roux-en-Y 吻合术疗效最为显著。

Abstract:

Objective：To observe the effect of 3 kinds of digestive tract reconstruction on postoperative blood glucose and complica－tions in patients with gastric cancer（GC） combined with type 2 diabetes，who received radical gastrectomy. Methods：Forty-seven gas－tric cancer patients with type 2 diabetes who received routine open gastrectomy in the First Affiliated Hospital of Guangxi Medical University were retrospectively analyzed from January 2003 to October 2012. The 47 patients were grouped into Billroth Ⅰ（Group A，n=12），Billroth Ⅱ（Group B，n=20） and Roux-en-Y group（Group C，n=15）. Fasting plasma glucose（FPG） and 2-hour plasma glucose（2hPG） before the operative and at 1 week，2 weeks，1 month and 3 months after the operation were recorded and compared among different groups. Meanwhile postoperative complications in the three groups were observed during the hospitalization. Results：There were statistically significant differences in FPG before the operation and at 1 month and 3 months after the operation（P<0.01）. There were statistically significant differences in 2hPG before the operation and at 1 week，2 weeks，1 month and 3 months after the operation（P<0.01）. Remission rate of DM2 was 30.00%，77.78% and 84.62% in group A，B，and C，respectively. Incidence of postop－erative complications was 41.67%，50.00% and 33.33% in group A，B，and C，respectively. Overall incidence of postoperative compli－cations was 42.55%，and the main complication was pulmonary infection（19.15%）. Conclusions：Among the three digestive tract re－constructions（Billroth Ⅰ，Billroth Ⅱ and Roux-en-Y） in radi－cal gastrectomy for patients with GC complicated with DM2，Billroth Ⅱ and Roux-en-Y can improve the blood glucose lev－els efficiently，and Roux-en-Y is the most efficient.