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目的探讨Roux-en-Y吻合重建对胃癌合并T2DM患者血糖水平、胰岛功能及并发症的影响。方法根据手术方式将120例Ⅰ~Ⅱ期胃癌合并T2DM患者随机分为观察组62例及对照组58例,对照组行胃食管吻合术,观察组行Roux-en-Y吻合重建术,比较两组治疗前后血糖及胰岛素的变化。结果术后6个月,观察组BMI[(23.36±2.44)vs(25.33±2.92)kg/m2]、FPG[(5.58±2.02)vs(8.96±1.75)mmol/L]、2hPG[(10.36±3.22)vs(13.82±2.77)mmol/L]、HbA1c[(4.28±1.36)%vs(9.22±1.25)%]、HOMA-IR[(2.12±0.85)vs(4.02±1.22)mIU/L]、HOMA-β[(3.89±0.82)vs(4.58±0.79)mmol/L]均低于对照组(P<0.05)。观察组术后6个月FIns[(14.28±1.33)vs(10.78±2.36)mIU/L]、FC-P[(3.98±1.02)vs(1.39±0.45)μg/L]、2hIns[(38.12±3.98)vs(33.28±4.15)mIU/L]、2hC-P[(9.86±2.12)vs(5.18±1.52)μg/L]较术前升高(P<0.05)。观察组近期并发症发生率和远期并发症发生率均低于对照组[3.22%vs 17.20%;4.84%vs 18.96%,P<0.05]。结论 Roux-en-Y吻合术能有效改善胃癌合并T2DM患者胰岛β细胞功能,降低血糖水平,术后并发症发生率低,安全有效。
Objective To investigate the effect of Roux-en-Y anastomosis reconstruction on the blood glucose level, islet function and complications in gastric cancer patients with T2DM. Methods A total of 120 patients with stage Ⅰ ~ Ⅱ gastric cancer complicated with T2DM undergoing surgery were randomly divided into observation group (62 cases) and control group (58 cases). The control group was treated by gastroesophageal anastomosis. The observation group was treated by Roux-en-Y anastomosis reconstruction. Changes of blood glucose and insulin before and after treatment. Results After 6 months, the BMI in the observation group (23.36 ± 2.44 vs 25.33 ± 2.92 kg / m2), FPG (5.58 ± 2.02 vs 8.96 ± 1.75 mmol / L, 2 hPG [(10.36 ± HbA1c [(4.28 ± 1.36)% vs (9.22 ± 1.25)%], HOMA-IR [(2.12 ± 0.85) vs (4.02 ± 1.22) mIU / L] HOMA-β [(3.89 ± 0.82) vs (4.58 ± 0.79) mmol / L] was lower than that of the control group (P <0.05). FIns [(14.28 ± 1.33) vs (10.78 ± 2.36) mIU / L], FC-P [3.98 ± 1.02 vs 1.39 ± 0.45 μg / L] and 2hIns [(38.12 ± 3.98 vs 33.28 ± 4.15 mIU / L and 2hC-P [(9.86 ± 2.12) vs (5.18 ± 1.52) μg / L], respectively. The incidences of complications and long-term complication in the observation group were lower than those in the control group [3.22% vs 17.20%; 4.84% vs 18.96%, P <0.05]. Conclusion Roux-en-Y anastomosis can effectively improve pancreatic β-cell function and reduce blood glucose levels in patients with gastric cancer and T2DM. The incidence of postoperative complications is low and safe and effective.