| ObjectiveTo investigate the effect of different gastrointestinal tract reconstruction methods on blood glucose levels in patients with gastric cancer complicated with diabetes,to study the application of insulin pump in postoperative blood glucose control,and to initially analyze the proper choice of gastrointestinal reconstruction methods and postoperative blood glucose control strategies for gastric cancer combined with diabetes.MethodsA total of 318 gastric cancer patients with diabetes mellitus who had undergone gastroenteric reconstructive surgery during the period from June 2013 to February 2017 were selected for retrospective analysis and were divided into three groups based on the patient's gastrointestinal reconstruction surgery.The specific grouping is as follows:109 patients in group I(adoption of Billroth I anastomosis),104 patients in group II(adoption of Billroth II anastomosis)and 105 patients in group RY(with Roux-en-Y anastomosis).The changes of abdominal blood glucose(FPG)before and after operation of 1 weeks,after operation of 2 weeks and after operation of 4 weeks,postprandial 2h blood glucose(2hPG),fasting glucagon like peptide-1(FGLP-1)and postprandial 2h glucagon like peptide-1(2h GLP-1)were observed and analyzed.Group I and Group II were divided into 2 subgroups of the insulin pump subgroup(controlled by insulin pump after operation)and the conventional subgroup(postoperative use of conventional insulin dosing method)according to postoperative insulin administration methods.In group I,there were 49 cases in the insulin pump subgroup and 60 cases in the conventional subgroup.In group II 104,there were 48 cases in insulin pump subgroup and 56 cases in the conventional subgroup.The changes of fasting blood glucose(FPG)before and after treatment,4 weeks after treatment,8 weeks after treatment and 12 weeks after treatment,postprandial 2h blood glucose(2hPG),fasting glucagon like peptide-1(FGLP-1)and postprandial 2h glucagon like peptide-1(2h GLP-1)were observed and analyzed,and the differences in blood glucose control efficacy,complications,insulin dosage,blood glucose attainment time and length of stay were compared.ResultsA total of 318 patients with gastric cancer complicated with type 2 diabetes were included.1.There were no significant difference in FPG,2hPG,FGLP-1,and 2h GLP-1 before surgery in all groups(P>0.05).After the reconstruction of the digestive tract,the FPG,2hPG,FGLP-1 and 2h GLP-1 of group I,group II and Group RY were significantly lower than the preoperative levels within the group(p<0.05).2.The improvement effects of FPG,2hPG,FGLP-1 and 2h GLP-1of Group I and Group II were significantly lower than those in RY group,and the incidence of complications of Group I and Group II was significantly higher than that of RY group(p<0.05).3.There was no statistically significant difference in FPG,2hPG,FGLP-1 and 2h GLP-1 between the preoperative insulin pump subgroup and the conventional subgroup(p>0.05).After treatment,FPG,2hPG,FGLP-1,2h GLP-1 of the insulin pump subgroup,and the conventional subgroup were significantly better than those before treatment.Although the improvement effects of FGLP-1 and 2h GLP-1 between the two groups after treatment were not statistically different,FPG,2hPG,insulin dosage,and complication rate of the insulin pump subgroup were significantly lower than those in the conventional subgroup(p<0.05),and the effective rate of blood glucose control was significantly higher than that of the conventional subgroup(p<0.05).Conclusion1.Billroth I anastomosis,Billroth II anastomosis and Roux-en-Y anastomosis can all reduce the blood glucose level in gastric cancer patients with diabetes,improve the secretion of glucagon-like peptides and have a certain effect on gastric cancer and diabetes.But the treatment effect of different gastrointestinal reconstruction is not exactly the same,of which the Billroth I anastomosis and Billroth II anastomosis have similar therapeutic effect,and Roux-en-Y anastomosis is more effective than the Billroth anastomosis.2.Insulin administration after gastrointestinal reconstruction can have a certain effect on the control of blood glucose.Compared with the conventional insulin administration,using insulin pump to control blood glucose not only has better control effect,but also has less insulin and fewer complications.It is recommended that gastric cancer patients with diabetes after gastrointestinal reconstruction is the preferred insulin pump to control blood glucose.3.It is suggested that the insulin pump should be used to control blood glucose after gastrointestinal reconstruction in gastric cancer patients with diabetes. |
PDF Full Text Request