中华内分泌外科杂志
中華內分泌外科雜誌
중화내분비외과잡지
CHINESE JOURNAL OF ENDOCRINE SURGERY
2014年
6期
459-462
,共4页
II型糖尿病%胃癌%消化道重建%Roux-en-Y%营养%糖代谢
II型糖尿病%胃癌%消化道重建%Roux-en-Y%營養%糖代謝
II형당뇨병%위암%소화도중건%Roux-en-Y%영양%당대사
Type II diabetes mellitus%Gastric cancer%Gastrointestinal reconstruction%Roux-en-Y%Nutrition%Glycemic metabolism
目的：观察远端胃大部切除不同消化道重建术式对2型糖尿病（ type 2 diabetes mellitus ， T2DM）胃癌患者术后营养状况及血糖的影响。方法 T2DM胃癌患者88例行根治性远端胃切除术，其中43例行毕I式重建，22例行毕II式重建，23例行Roux-en-Y重建。观察手术前、术后1年3组患者BMI、血清白蛋白、前白蛋白指标，并随访患者糖尿病的控制情况。结果手术前3组患者一般资料及各检测指标差异无统计学意义（ P＞0.05）。术后1年，3组患者BMI、血清白蛋白、前白蛋白均较术前有不同程度的减低，但各组之间指标差异无统计学意义（ P＞0.05）。毕I式组控制血糖的有效率为18.60％，毕II式组为72.73％，Roux-en-Y组为73.91％，3组之间差异有统计学意义（χ2＝17.3903，P＜0.05）。毕II式与Roux-en-Y组控制血糖的有效率均高于毕I式组（χ2＝18.3409，P＜0.05；χ2＝19.4804，P＜0.05）。毕II式与Roux-en-Y组之间则差异无统计学意义（χ2＝0.0081，P＝0.9284）。结论远端胃大部切除后，毕II式与Roux-en-Y重建可改善T2DM胃癌患者血糖代谢，且并不明显影响患者营养状况。
目的：觀察遠耑胃大部切除不同消化道重建術式對2型糖尿病（ type 2 diabetes mellitus ， T2DM）胃癌患者術後營養狀況及血糖的影響。方法 T2DM胃癌患者88例行根治性遠耑胃切除術，其中43例行畢I式重建，22例行畢II式重建，23例行Roux-en-Y重建。觀察手術前、術後1年3組患者BMI、血清白蛋白、前白蛋白指標，併隨訪患者糖尿病的控製情況。結果手術前3組患者一般資料及各檢測指標差異無統計學意義（ P＞0.05）。術後1年，3組患者BMI、血清白蛋白、前白蛋白均較術前有不同程度的減低，但各組之間指標差異無統計學意義（ P＞0.05）。畢I式組控製血糖的有效率為18.60％，畢II式組為72.73％，Roux-en-Y組為73.91％，3組之間差異有統計學意義（χ2＝17.3903，P＜0.05）。畢II式與Roux-en-Y組控製血糖的有效率均高于畢I式組（χ2＝18.3409，P＜0.05；χ2＝19.4804，P＜0.05）。畢II式與Roux-en-Y組之間則差異無統計學意義（χ2＝0.0081，P＝0.9284）。結論遠耑胃大部切除後，畢II式與Roux-en-Y重建可改善T2DM胃癌患者血糖代謝，且併不明顯影響患者營養狀況。
목적：관찰원단위대부절제불동소화도중건술식대2형당뇨병（ type 2 diabetes mellitus ， T2DM）위암환자술후영양상황급혈당적영향。방법 T2DM위암환자88례행근치성원단위절제술，기중43례행필I식중건，22례행필II식중건，23례행Roux-en-Y중건。관찰수술전、술후1년3조환자BMI、혈청백단백、전백단백지표，병수방환자당뇨병적공제정황。결과수술전3조환자일반자료급각검측지표차이무통계학의의（ P＞0.05）。술후1년，3조환자BMI、혈청백단백、전백단백균교술전유불동정도적감저，단각조지간지표차이무통계학의의（ P＞0.05）。필I식조공제혈당적유효솔위18.60％，필II식조위72.73％，Roux-en-Y조위73.91％，3조지간차이유통계학의의（χ2＝17.3903，P＜0.05）。필II식여Roux-en-Y조공제혈당적유효솔균고우필I식조（χ2＝18.3409，P＜0.05；χ2＝19.4804，P＜0.05）。필II식여Roux-en-Y조지간칙차이무통계학의의（χ2＝0.0081，P＝0.9284）。결론원단위대부절제후，필II식여Roux-en-Y중건가개선T2DM위암환자혈당대사，차병불명현영향환자영양상황。
Objective To observe the effects of different gastrointestinal reconstruction methods after dis -tal subtotal gastrectomy on nutritional condition and blood glucose in patients with type 2 diabetes ( T2DM) and gastric cancer.Methods 88 patients with T2DM and gastric cancer undergoing radial distal gastrectomy were studied and among them 43 patients had Billroth I gastrointestinal reconstruction , 22 patients had Billroth II gas-trointestinal reconstruction and 23 patients had Roux-en-Y gastrointestinal reconstruction .Body mass index ( BMI) , serum albumin and prealbumin of the 3 groups were measured preoperatively and 1 year after surgery . The patients were followed up .Results There was no significant difference among the 3 groups in preoperative values(P>0.05).One year after surgery, BMI, serum albumin and peralbumin in the 3 groups had different de-grees of reduction , but showed no statistical difference ( P>0.05 ) .The effective rate of diabetes control was 18.60%in Billroth I group , 72.73%in Billroth II group , and 73.91% in Roux-en-Y group and the difference had statistical significance(χ2 =17.390 3,P<0.05).The effective rates of diabetes control in Billroth II group and Roux-en-Y group were higher than that in Billroth I group (χ2 =18.340 9,P<0.05;χ2 =19.480 4,P<0.05), and there was no evident difference between Billroth II group and Roux-en-Y group(χ2 =0.008 1,P=0.928 4).Conclusion Billroth II and Roux-en-Y gastrointestinal reconstruction can improve glycemic metabo-lism of patients with T2DM and gastric cancer without significantly reducing the nutrition status .
