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目的探讨胃窦部癌合并2型糖尿病患者采取不同消化道重建方式后对患者血糖的影响。方法回顾性分析我院2006年1月至2012年1月期间行根治性手术治疗的51例胃窦部癌合并2型糖尿病患者的临床资料,根据消化道重建方式不同分为BillrothⅠ式组(14例)、BillrothⅡ式组(28例)及Roux-en-Y组(9例)3组,对比分析3组以下指标:①比较3种重建方式患者术前、术后1个月及术后6个月的空腹血糖(FBG)、餐后2 h血糖(PG2h)水平;②术前、术后6个月糖化血红蛋白(HbA1c)的水平;③3组糖尿病的控制情况。结果 BillrothⅠ式组术后1个月和术后6个月的FBG、PG2h水平与术前比较差异均无统计学意义(P>0.05),BillrothⅡ式组和Roux-en-Y组术后1个月和术后6个月的FBG、PG2h水平均明显低于术前(P<0.05);术后1个月和术后6个月的FBG、PG2h水平,BillrothⅡ式组和Roux-en-Y组间比较,差异均无统计学意义(P>0.05),但BillrothⅡ式组和Roux-en-Y组均明显低于BillrothⅠ式组(P<0.05)。BillrothⅠ式组术前与术后6个月间的HbA1c水平比较,差异无统计学意义(P>0.05);BillrothⅡ式组和Roux-en-Y组术后6个月HbA1c值均明显低于术前(P<0.05)。术后6个月,BillrothⅡ式组和Roux-en-Y组的HbA1c值均分别明显低于BillrothⅠ式组(P<0.05);BillrothⅡ式组和Roux-en-Y组间的HbA1c值比较,差异无统计学意义(P>0.05)。BillrothⅡ式组和Roux-en-Y组患者总体疗效均分别明显优于BillrothⅠ式组患者(P=0.000,P=0.000),BillrothⅡ式组和Roux-en-Y组间比较差异均无统计学意义(P=0.259)。结论根据本组有限病例资料的研究表明,BillrothⅡ式吻合及Roux-en-Y吻合对于胃窦部癌合并2型糖尿病的患者可能是最佳的手术方式。
Objective To investigate the effect of different digestive tract reconstruction methods on blood glucose in patients with gastric cancer and type 2 diabetes mellitus. Methods The clinical data of 51 patients with gastric cancer with type 2 diabetes mellitus who underwent radical surgery between January 2006 and January 2012 in our hospital were retrospectively analyzed. According to different types of digestive tract reconstruction, they were divided into Billroth Ⅰ group (14 (N = 28) and Roux-en-Y (n = 9). The three groups of the following indicators were compared: ① Comparison of three reconstruction methods before surgery, one month after surgery and six months after surgery Month fasting blood glucose (FBG), 2 h postprandial blood glucose (PG2h) levels; ② preoperative and postoperative 6 months of hemoglobin (HbA1c) levels; ③ group 3 diabetes control. Results The levels of FBG and PG2h at 1 month and 6 months after operation in Billroth Ⅰ group were not significantly different from those before operation (P> 0.05), while those in Billroth Ⅱ group and Roux-en-Y group The levels of FBG and PG2h at 6 months and 6 months after operation were significantly lower than those before operation (P <0.05). The levels of FBG and PG2h at 1 month and 6 months after operation were significantly lower than those in Billroth Ⅱ group and Roux-en-Y There was no significant difference between the two groups (P> 0.05). However, both BillrothⅡgroup and Roux-en-Y group were significantly lower than those of BillrothⅠgroup (P <0.05). There was no significant difference in HbA1c level between preoperative and postoperative 6-month in BillrothⅠgroup (P> 0.05); HbA1c in BillrothⅡgroup and Roux-en-Y group at 6 months postoperatively were significantly lower than those in BillrothⅡgroup Before (P <0.05). The HbA1c of BillrothⅡgroup and Roux-en-Y group were significantly lower than that of BillrothⅠgroup (P <0.05) at 6 months after operation. The difference of HbA1c between BillrothⅡgroup and Roux-en-Y group was significant No statistical significance (P> 0.05). The overall efficacy of BillrothⅡgroup and Roux-en-Y group were significantly better than that of BillrothⅠgroup (P = 0.000, P = 0.000), but there was no significant difference between BillrothⅡgroup and Roux-en-Y group (P = 0.259). Conclusions Based on the limited case data in this study, Billroth Ⅱ anastomosis and Roux-en-Y anastomosis may be the best surgical modality for patients with gastric cancer with type 2 diabetes mellitus.