摘要
目的:初步探讨毕Ⅱ式吻合和ROUX-en-Y吻合对2型糖尿病(type 2 diabetes mellitus,T2DM)患者胃大部分切除术后糖代谢的影响。方法:选择2011年8月至2014年8月在我院因胃部疾病接受胃大部分切除术且合并T2DM患者116例,按照手术方式分为2组:毕Ⅱ式吻合组(A组:60例)和ROUX-en-Y吻合组(B组:56例),对比2组术前和术后1、3、6个月的空腹血糖(fasting blood glucose,FBG)、餐后2小时血糖(postprandial blood glucose,PBG)、糖化血红蛋白(hemoglobin Alc,Hb Alc)和胰岛素抵抗指数(insulin resistance index,IRI),并评价术后6个月T2DM改善情况。结果:A、B组术后1、3、6月FBG分别为:(7.85±2.04)vs.(7.04±1.93)、(7.75±1.82)vs.(6.84±1.83)、(7.81±1.95)vs.(6.72±1.74);FBG分别为:(12.26±2.30)vs.(11.15±2.28)、(12.12±2.41)vs.(10.74±2.52)、(11.56±2.37)vs.(10.48±2.32);Hb Alc分别为:(7.46±2.56)vs.(7.92±2.40)、(7.61±2.79)vs.(6.67±2.14)、(7.39±1.91)vs.(6.55±2.24);IRI分别为:(6.46±2.29)vs.(5.49±2.35)、(5.86±1.72)vs.(4.44±1.96)、(5.45±1.40)vs.(4.05±1.89)。重复测量方差分析结果显示:FBG、PBG、IRI在不同分组、不同时间以及分组与时间的交互作用均具有统计学意义(P<0.05),Hb Alc仅时间因素具有统计学意义(P<0.05),A组有效率明显低于B组(61.67%vs.78.57%,P<0.05)。结论:毕Ⅱ式和ROUX-en-Y吻合对术后T2DM均有一定改善,ROUX-en-Y吻合疗效更优,具体机制不详,若在临床广泛开展,安全性、可行性有待进一步探索。
Objective：To discuss the efficacy of Billroth Ⅱ and ROUX-en-Y anastomosis for type 2 diabetes mellitus（T2DM）patients with gastric diseases underwent subtota gastrectomy. Methods：Totally 116 patients with T2 DM underwent subtota gastrectomy in our hospital from August 2012 to August 2014 were selected,and were divided into A group（Billroth Ⅱ group,60 cases）and B group（ROUX-en-Y group,56 cases）. The level of fasting blood glucose（FBG）,postprandial blood glucose（PBG）,hemoglobin Alc（Hb Alc）,insulin resistance index（IRI）at different observation time points and clinical effect were compared between two groups. Results：In A group and B group at 1,3,6 months after operation,the FBG levels were（7.85±2.04）vs.（7.04±1.93）,（7.75±1.82）vs.（6.84±1.83）,（7.81 ±1.95） vs.（6.72 ±1.74） respectively;the PBG levels were（12.26 ±2.30） vs.（11.15 ±2.28）,（12.12 ±2.41） vs.（10.74±2.52）,（11.56±2.37）vs.（10.48±2.32）respectively;the Hb Alc levels were（7.46±2.56）vs.（7.92±2.40）,（7.61±2.79）vs.（6.67±2.14）,（7.39±1.91）vs.（6.55±2.24）respectively;the IRI were（6.46±2.29）vs.（5.49±2.35）,（5.86±1.72）vs.（4.44±1.96）,（5.45±1.40）vs.（4.05±1.89）respectively. The results of ANOVA for repeated measurement showed that there were significant differences among FBG,PBG and IRI at different groups,different time points,different interaction between groups and time points（P〈0.05）. But Hb Alc showed significant differences at different time points（P〈0.05）. The total good rate of A group were significantly lower than that of B group（61.67% vs. 78.57%,P〈0.05）. Conclusion：Billroth Ⅱ and ROUX-en-Y anastomosis have certain clinical effect on T2 DM,and ROUX-en-Y anastomosis is superior to Billroth Ⅱ anastomosis. But the mechanism of the treatment is not clear,so the safety and feasibility of Billroth Ⅱ and ROUX-enY anastomosis for T2 DM needs further study.
出处
《重庆医科大学学报》
CAS
CSCD
北大核心
2016年第5期526-529,共4页
Journal of Chongqing Medical University
