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目的探讨不同胃癌根治术及Roux-en-Y吻合术对合并胃癌的2型糖尿病(T2DM)患者的治疗效果。方法回顾性分析胃肠外科2009年3月至2011年3月收治的胃癌合并2型糖尿病患者75例行胃癌根治性手术+Roux-en-Y吻合术的临床资料,按照手术方法分为远端胃切除组+改良Roux-en-Y吻合术组(30例),根治性全胃切除术+改良Roux-en-Y吻合术组(25例)以及胃癌根治术(远端/全胃)+常规Roux-en-Y吻合术组(20例)。根据术后1年时糖化血红蛋白水平及药物使用情况进行疗效评估,比较各种手术方式的疗效。结果远端胃癌根治术和根治性全胃切除术(均行改良Roux-en-Y吻合术)一定程度改善胃癌合并T2DM患者术后糖化血红蛋白水平,并对缓解T2DM有一定的疗效,但无统计学差异(P均>0.05)。行改良Roux-en-Y吻合术和常规Roux-en-Y吻合术均可一定程度改善胃癌合并T2DM患者术后糖化血红蛋白水平,并对缓解T2DM有一定的疗效,但无统计学差异(P均>0.05)。结论根治性全胃切除术与远端胃癌根治术行Roux-en-Y吻合术均可降低胃癌合并2型糖尿病患者糖化血红蛋白水平及血糖水平,并对缓解T2DM有一定的疗效,是否保留残胃和Roux-en-Y吻合术中所留Roux肠袢的长短与疗效无明显关系。
Objective To investigate the curative effect of different gastric cancer radical mastectomy and Roux-en-Y anastomosis on type 2 diabetes mellitus (T2DM) patients with gastric cancer. Methods The clinical data of 75 patients with gastric cancer treated by radical surgery + Roux-en-Y anastomosis from July 2009 to March 2011 in patients with gastric cancer and type 2 diabetes mellitus were retrospectively analyzed. The patients were divided into distal Gastrectomy group + modified Roux-en-Y anastomosis group (30 cases), radical gastrectomy + modified Roux-en-Y anastomosis group (25 cases) and radical gastrectomy (distal / full stomach) The routine Roux-en-Y anastomosis group (20 cases). According to the 1-year postoperative glycosylated hemoglobin level and the use of drug efficacy evaluation, compare the efficacy of various surgical methods. Results Both distal radical gastrectomy and radical total gastrectomy (modified Roux-en-Y anastomosis) could improve the postoperative HbA1c of gastric cancer patients with T2DM and relieve T2DM, but there was no statistical significance Learning difference (P> 0.05). Both modified Roux-en-Y anastomosis and routine Roux-en-Y anastomosis can improve the level of HbA1c in patients with gastric cancer complicated with T2DM to a certain extent and have some curative effect on relieving T2DM, but there is no statistical difference (P > 0.05). Conclusions Both radical gastrectomy and Roux-en-Y anastomosis for distal gastric cancer can reduce the level of glycosylated hemoglobin and blood glucose in patients with type 2 diabetes mellitus and gastric cancer and relieve the effect of T2DM, There was no significant relationship between the Roux-en-Y anastomosis Roux intestinal bowel and curative effect.