Observation Of Different Digestive Tract Reconstruction For Gastric Cancer On Blood Glucose In Patients Complicated With Type2Diabetes

BackgroundThe incidence of gastric cancer is in the first place in a variety of malignant tumors in China.And Diabetes as a common and frequently-occurring disease, with people’s living standards improve,lifestyle changes and increasing aging population, its incidence is increasing year by year, including type2diabetes accounts for about95%of the total number of diabetes Therefore,the gastric cancer complicated with type2diabetes is common in clinical. Diabetes can only rely on long-term diet control, physical exercises, oral hypoglycemic agents or insulin injections to maintain blood glucose levels within the normal range.In recent years there is a considerable number of domestic and foreign literature reporting that the blood glucose of some gastric cancer patients with type2diabetes who have taken surgeries could be at a satisfactory level.,even without diet or drug treatment.ObjectiveThrough clinical observation and postoperative follow-up ways to explore the effect of different digestive tract reconstruction after radical surgery for gastric cancer on blood glucose in patients complicated with type2diabetes.MethodsStudy population are52cases of gastric cancer patients complicated with type2diabetes which were diagnosed at the Second Hospital of Shandong University during the January2008and January2010.The number of male cases is32,and the female is30.The age of the cases are between36and 69,the Average age is52±7.2.All the cases are diagnosed gastric cancer by endoscopic biopsy and without distant metastases before operation, including28cases of gastric body cancer and24cases of gastric antrum cancer.By different kinds of digestive tract reconstruction,these patients were divided into3groups-Group A:Billroth Ⅰ (n=22,male14,female8,age range39-65,average age52±6.7),Group B:BillrothⅡ+Braun(n=18,male11,female7,age range36-67,average age51±7.8)and Group C:Roux-en-Y(n=12,male7,female5,age range42-69,average age54±5.4).All the cases underwent radical gastrectomy and D2lymph node dissection under general anaesthesia. Preoperatively discontinue long-term hypoglycemic drug for one week and short-acting hypoglycemic drug for three days,and record fasting plasma glucose(FPG) and2hours plasma glucose(2hPG) after breakfast.According to the change of blood gulcose,hypoglycemic drug can be adjusted to control blood glucose within10mmol/L after collection of data.In one week after opertation hypoglycemic drug can be used,and then just take diet therapy and physical exercises instead of drugs. If FPG>7.0mmol/L or2hPG>10.0mmol/L, the short-acting insulin treatment could be given. After surgeries follow up all patients for more than one year, and collect records of postoperative FPG and2hPG after breakfast in one month,six months and one year.Results:Comparing to the level before operation,the levels of FBG and2hPG after operation one month,six months and one year showed a descent in group B and group C(P<0.01),and there was also more improvement than group A(P<0.01).And there were no differences in the level of blood glucose between before operation and after operation in gorup A(P>0.05) The effect rates of blood glucose control after operation one year were22.73%,72.22%,75.00%for group A,group B and group C respectively.And there was difference among the three groups (aP<0.0167)Conclusion It is effective for controlling the blood glucose of gastric cancer patients complicated with type2diabetes with Billroth Ⅱ or Roux-en-Y gastrectomy after radical surgery.