| Background:The prevalence of diabetes in China is rapidly rising trend,become after cardiovascular disease and tumor and a serious threat to the health of the people of chronic noncommunicable diseases.at present mainly take medical treatment such as life coaching(control diet,strengthening exercise),drug glucose-lowering and insulin injections,but medical treatment is not good to maintain blood glucose levels and prevent related complications,and long-term use of an oral glucose-lowering drug brings the risk of drug side effects.But in recent years a large number of studies have found that gastric cancer patients with type 2 diabetes after gastric cancer surgery,some patients with small dose of the drug and the amount of insulin can be control of blood sugar better than before,there are some patients can get good control blood sugar levels without having to control diet and application of hypoglycemic drugs.Visiblly,surgical method provides a new direction for the treatment of diabetes,but at the moment for the curative effect of different surgical methods for the control of the diabetes is debatable.Purpose: Through Billroth Ⅰ type and Roux-en-Y type Gastrectomy were retrospectively analyzed that two kinds of different ways of the digestive tract reconstruction have the effect of blood sugar and therapeutic effect in gastric cancer patients with type 2 diabetes.Methods: Collected in September 2011-March 2015 in Qingdao municipal hospital general surgery accept stomach Billroth Ⅰ type and Roux-en-Y type of cancer of the stomach and digestive tract reconstruction surgery in patients with type 2 diabetes 60 cases,22 cases of women,men 38 cases,aged 50 to 81 years old.According to the different way of the digestive tract reconstruction will be divided into two groups: group A: Billroth Ⅰ type 16 cases,8 cases of men,women,8 cases,the average age(58.19±8.42);Group B: Roux-en-Y type 44 cases,28 cases of male,female 16 cases,average age(58.90 ± 8.52).Into the patient’s postoperative for regular inspection and chemotherapy in hospital for many times,collect patients with preoperative and postoperative 1,3,6 months of body weight,fasting blood glucose,blood sugar 2 hours after meal,such as indicators,and record in patients with preoperative and postoperative conditions of drug utilization of the 6 months.,respectively,compared with 1,3,6months after the body weight,fasting blood glucose,blood sugar 2 hours after meal and the change of the preoperative,at the same time,the above indexes comparison between groups,observe its change.Compared with preoperative and postoperative conditions of drug utilization of the 6 months and to evaluate the effect of two groups of surgical methods for diabetes control.For good diabetes control a group of single factor analysis,further understand the related factors influencing the postoperative diabetes patients with ease.Result:Two groups of patients were age,sex,weight,blood sugar and other indicators to compare(P > 0.05),no obvious difference.After postoperative follow-up regularly found: group A(Billroth Ⅰ)1,3,6 months postoperatively in patients with A preoperative fasting glucose were decreased [(7.19±1.49),(7.12 ±1.48),(1.48±1.37)VS(8.55 ±2.19),P < 0.05];Compared with preoperative blood sugar 2 hours after meals are falling[(9.77± 1.37),(9.07±1.17),(1.17 ±1.13)VS(10.45±1.77),P < 0.01];But also with body mass index(BMI)compared with the preoperative [(21.70 ± 2.14),(21.38 ±2.06),(2.06 ± 2.24)VS(24.72 ± 2.00),P<0.05].Group B(Roux-en-Y type)in patients with postoperative follow-up time(1,3,6 months)in the preoperative fasting glucose significantly lower [(6.69 ± 1.16),(6.05 ± 1.02),(6.17 ± 0.96)VS(8.62 ± 2.45),P<0.01];Compared with preoperative blood sugar 2 hours after meal also had significantly lower[(8.53±1.54)、(8.18±1.03)、(7.24±0.95)VS(11.55±2.74),P<0.01];Body mass index also significantly lower[(21.95±2.47)、(21.35±2.49)、(21.19±2.44)VS(24.63±3.00),P <0.01]。In A follow-up time will group A compared with group B patients found that recently(one month)after fasting plasma glucose[(7.19±1.49)VS(6.69±1.16),P = 0.268],blood sugar 2 hours after meal [(9.29±1.05)VS(8.53±1.54),P = 0.081] And body mass index [(21.70±2.14)VS(21.95±2.47),P=0.604],no obvious difference between the two groups;Short term(3 months)and long term(6 months)of fasting blood glucose levels have obvious difference [(7.12±1.48)VS(6.05±1.02),P = 0.014;(6.96±1.37)VS(6.17±0.96),P = 0.039].There exist obvious differences in blood sugar 2 hours after meal[(9.07±1.17)VS(8.18±1.03),P = 0.024;(9.03±1.13)VS(7.24±0.95),P<0.01],and visible group B patients postoperative fasting blood glucose and postprandial 2 h blood glucose control is better than that of group A;Two groups of patients with postoperative body weight were decreased,but the change of body mass index(BMI)and no obvious difference between the two groups[(21.38±2.06)VS(21.35±2.49),P>0.05;(21.45±2.24)VS(21.19±2.44),P>0.05].group A(Billroth Ⅰ type)and group B(Roux-en-Y type)6 months postoperatively in patients with two groups of blood glucose control effectiveness were 37.5% and 81.8% respectively(P < 0.01),compared two groups have significant statistical difference.On good blood sugar control group B(Roux-en-Y type)line 6 months after the curative effect of single factor analysis,showed postoperative associated with BMI and the course of the disease in patients with preoperative blood sugar control,has nothing to do with the gender,age,preoperative fasting blood glucose levels.Conclusion: 1,Billroth Ⅰ and Roux en-Y reconstruction have a certain effect for the treatment of type 2 diabetes,and Roux en-Y type’s treatment effect is better than that of Billroth Ⅰ type.2,Gastrectomy with Roux en-Y reconstruction’s long curative effect in type 2 diabetes is associated with preoperative body weight index and the length of the course of the disease. |
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