CAJ | 학술논문

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(HbA1C)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HbA1c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.
목적 탐토위암근치술연합개량위방로술치료위암합병2형당뇨병환자적림상효과.방법 회고성분석아과2007년10월-2014년10월수치적72례위암합병2형당뇨병환자적림상자료,근거위종류부위선택수술방법적불동분위원단위조30례,근단위조14례화전위조28례,분별여원단위암근치술、근단위암근치술、근치성전위절제술연합개량식잔위공장Roux-en-y문합술. 술후관찰각조수술병발증,술전급술후1、6개월공복혈당( FPG)、찬후2 h혈당(2h PG)급당화혈홍단백(HbA1C)수평,이급수술후1년암전이정황. 결과 본조수술균획성공,술후주원시간9~25 d,진식급영양정황량호,술후회복순리. 술후무엄중수술병발증발생. 술후1개월、6개월3조FPG、2h PG급HbA1c균명현하강(P<0. 01혹P<0. 05). 술후1년각조무사망병례,원단위조발생간장전이2례,근단위조발생간장전이、폐전이각1례,전위조발생복강전이2례、간장전이1례. 결론 위암근치술연합개량위방로술치료위암합병2형당뇨병환자조작간단,안전가행,유흔호적림상응용전경.
Objective To investigate the clinical effect of radical gastrectomy combined with modified gastric by-pass in treatment of gastric cancer patients with type 2 diabetes mellitus. Methods Clinical data of 72 gastric cancer pa-tients with type 2 diabetes mellitus during October 2007 and October 2014 was retrospectively analyzed. The 72 patients were divided into distal gastrectomy group ( n=30 ) , proximal gastrectomy group ( n=14 ) and total gastrectomy group ( n=28) according to different operative methods, and the three groups were respectively treated with operations of distal radical gastrectomy, proximal radical gastrectomy and radical total gastrectomy combined with modified Roux-en-Y anas-tomosis of remnant stomach and jejunum. The postoperative complications, fasting plasma glucose ( FBG) levels before and 1 and 6 months after the operation, 2 h postprandial glucose (2hPG) level, glycosylated hemoglobin (HbA1c) level and status of cancer metastasis in postoperative 1 year in the three groups were observed. Results All operations were performed successfully with postoperative 9-25 d of hospital stay, and all patients recovered well with good status of diet and nutrition. No severe postoperative complications were found in all patients. The levels of FBG, 2hPG and HbA1c 1 and 6 months after the operation were significantly decreased in the three groups (P<0. 01 or P<0. 05). With postoper-ative 1 year of follow-up, no death was reported, and there were 2 patients with liver metastasis in distal gastrectomy group, 1 patient with liver metastasis and 1 patient with lung metastasis in proximal gastrectomy group, and 2 patients with abdominal cavity metastasis and 1 patient with liver metastasis in total gastrectomy group. Conclusion The radical gastrectomy combined with modified gastric bypass in treatment of gastric cancer patients with type 2 diabetes mellitus has the advantages such as simple operation and safety.