Study In Postoperative Glycemia Control By Digestive Tract Reconstructionsin Patients With Gastric Cancer And Type 2 Diabetes Mellitus

Background With the aging of the population,the morbidity of gastric cancer combined with type 2 diabetes mellitus(T2DM)is increasing year by year in China,which is a country with a huge morbidity of gastric cancer and diabetes.With the concept of metabolic surgery proposed,more and more attention has been paid to the surgical treatment of T2DM.There are some similarities between the metabolic surgery and digestive tract reconstructions(Billroth?and Roux-en-Y anastomosis)in radical surgery of gastric cancer,providing a new way of treatment for those patients with gastric cancer and T2DMAim To compare the influence of the digestive tract reconstructions,which is divided into Billroth?and two different length of Roux loop of Roux-en-Y anastomosis,upon the control of blood glucose level and the remittence of T2DM,and discuss the mechanism of each operation in reducing blood glucose level,providing basis in the surgery treatment for those patients with two diseases mentioned above.Methods According to the criterias of inclusion and exclusion,78 cases of patients with the two diseases mentioned above were retrospectively analyzed.There are 41males and 37 females among them with an average of age(61.58±8.84)years,height(1.69±0.07)m,preoperative weight(64.46±9.28)Kg,preoperative BMI(22.61±2.86)Kg/m~2,preoperative FPG(13.72±1.34)mmol/L,preoperative 2hPG(16.07±1.91)mmol/L,preoperative HbA1c(8.88±0.60)mmol/L and the duration of T2DM(6[3,10])years.According to different type of anastomosis,these patients were divided into 3 groups:group A with Billroth?gastrojejunostomy(n=18),group B with esophagojejunostomy or Roux-en-Y gastrojejunostomy(n=30),whose length of Roux loop is 40cm,and group C with Roux-en-Y esophagojejunostomy or gastrojejunostomy(n=30),whose length of Roux loop is 100cm.Using statistical method,the level of FPG,2hPG,HbA1c and BMI before the operation and the third and the sixth month after the operation of each group were respectively compared.Results The three types of digestive tract reconstructions have efficacy in controlling the blood glucose level and BMI(P<0.05).On the effect of controlling blood glucose,the most efficient anastomosis is group C(P<0.05),while the least efficient anastomosis is group A(P<0.05);On the effect of controlling BMI,The three anastomosis compared have the same efficacy in each timing after the operation(P>0.05).Group C have the best curative effect in T2DM(P<0.05),while the other two digestive tract reconstructions have similar efficacy on the remittence of T2DM(P>0.05).Conclusion All three groups of anastomosis can improve the level of blood glucose of patients with gastric cancer combined with T2DM,which means that they have efficacy in curing T2DM.The Roux-en-Y anastomosis have better effect in controlling blood glucose,whose length of Roux loop could affect the efficacy.The Roux-en-Y anastomosis with 100cm length of Roux loop have better effect on the control of blood glucose and remittence of T2DM;the three anastomosis compared have similar effect upon the control of BMI.