| Objective:Gastric cancer is one of the common gastrointestinal cancer ranked third.Surgery is the treatment of its main means. There have three kinds of Alimentary Reconstruction during D2 dissection. Type 2 diabetes is the world’s highest incidence of endocrine diseases. Drug control and subcutaneous administration of insulin are the primary means of treatment of the disease. In recent years, surgical treatment of type 2 diabetes are being noticed by medical workers. A variety of surgical procedures has been shown to significantly improve or even cure type 2 diabetes,To assess the effect of different alimentary reconstruction on blood glucose and gastrointestina hormones in gastric cancer patients complicated with type 2 diabetes.Methods:The retrospective analysis was made in 69 cases of gastric cancer with type 2 diabetes from 20010 to 2015. These patients were divided into three groups,Group A(D2dissection with Billroth I)has 23 cases, Group B(D2dissection with Billroth I)has 20 cases,Groups C(D2dissection with esophago- jejunum or gastro- jejunum Roux-en-Y anastomosis)has 26 cases. The levels of fast blood glucose and 2h postprandial blood glucose,fast glucagon-like peptide-1(f GLP-1) and 2h postprandial glucagon-like peptide-1(2h GLP-1),fast glucose-dependent insulinotropic peptide(f GIP)and 2h postprandial glucose-dependent insulinotropic peptide(2h GIP) were detected in patients before,These blood samples were drawn at the clinic visitafter 1 week,1 month,3 months and 6months operation in three groups. Blood glucose levels detected by automatic biochemical analyzer machine. GLP-1 and GIP are enzyme-linked immunosorbent assay(ELISA) kit uniform testing method. Results:Comparing to the third group, the level of blood glucose and glucose-dependent insulinotropic peptide showed a steady and sustained descent in patients after 1 month and 6 months surgery in the Group A and Group B(P< 0.05),and the level of glucagon-like peptide-1 appeared a a steady and sustained increase in patients after 1 month and 6 months surgery in the Group A and Group B. But,these changes were not appeared in the Group A.However,the effective rates for the Billroth II and Roux-en-Y groups respectively were no difference between them(P> 0.05). Conclusion :It is an effective method for blood glucose control using surgery of Billroth II and Roux- en-Y anastomosis in gastric cancer patients with type 2 diabetes. GIP and GLP-1 in the Billroth II and Roux-en-Y anastomosis appeared secretion changes. But in the blood of patients after Billroth I group showed no improvement,and there is no significant difference in the secretion of GIP and GLP-1 compared with preoperative.Its mechanism may be considered as which Billroth type II and type Roux-en-Y reconstruction played a bypass surgery results. This experiment confirmed that due to the exclusion of the duodenum and jejunum part of such food on the proximal jejunum stimulus disappears, GIP release was significantly reduced compared with before surgery, insulin resistance ease. As the food to arrive early end back to the field which stimulate GLP-1 secretion increased. At last,it causes an increase in insulin secretion, and thus improving blood sugar has played a certain role. In no rows bypass surgery in patients with Billroth I group, the food will still be normal by the duodenum and proximal jejunu. Fasting and postprandial 2h GIP compared with the preoperative which has no significant decrease.High concentrations of GIP on insulin role still exists, postoperative diabetes improving effect is not obvious. As the food did not arrive early terminal ileum, GLP-1 secretion was no significant increase in insulin secretion which do not increase blood glucose improving effect. The probable mechanism of action is the production of GLP-1 and GIP change which caused by these two kinds of operation method leads to the insulin secretion,and it eventually reduces the patient’s fast blood glucose and 2h postprandial blood glucose. |
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