| Objective : Gastric cancer and diabetes are two diseases that endanger human health.Due to the rapid development of China's economy and the improvement of people's living standards,type 2 diabetes(T2DM)accounts for more than 90% of all patients with diabetes.This article uses a retrospective observation method to analyze the changes of blood glucose levels of patients with gastric cancer combined with type 2 diabetes before and after Roux-en-Y anastomosis,observe the changes of blood glucose in patients with gastric cancer combined with T2 DM in different cancer stages,and explore Roux-en-Influencing factors of Y anastomosis on patients' blood glucose remission.To explore the clinical efficacy of Roux-en-Y anastomosis in the treatment of gastric cancer with T2 DM.Methods: This article observes and analyzes 127 patients with gastric cancer and T2 DM who underwent general surgery at the Third Affiliated Hospital of Anhui Medical University from January 2016 to January 2019,including 56 males and 71 females.127 patients were grouped according to the new GC TNM(eighth edition)staging system released by the American Joint Committee on Cancer(AJCC)/ International Union for Cancer Control(UICC)in 2018.The results were: 52 patients with stage ? tumors(A Group),31 patients with stage ? tumors(group B)and 44 patients with stage ? tumors(group C).All patients underwent routine examinations such as blood counts,liver and kidney function,electrocardiograms and chest X-rays as well as FPG,2h PG and body mass index(BMI).The reconstruction of the digestive tract uses Roux-en-Y gastric jejunostomy,the Treitz ligament is 10-15 cm away from the jejunum,the distal end is anastomosed with the remaining stomach,and the proximal end is anastomosed at the distal jejunum 45-60 cm.Statistical analysis was performed using SPSS 17.0 statistical software.The measurement data are expressed as mean and standard deviation(x ± s).Use the independent sample t-test method.The count data were tested by chi-square test,and P <0.05 was considered statistically significant.Results:(1)Baseline data of patients: 52 patients in group A(Phase 1)and 26 males.And female,age(5.42 ± 4.01)years,BMI(25.37 ± 3.02)kg / ?,course of disease(5.42 ± 4.01)years;group B(Phase II)31 cases,18 males and 13 females,age(5.42 ± 4.01)years,BMI(25.21 ± 3.11)kg / ?,duration of disease(5.53 ± 3.72)years;44 cases in group C(stage III),26 males and 18 females,aged(5.42 ± 4.01)years,BMI(25.67)± 3.17)kg / ?,and the course of disease was(5.39 ± 4.13)years.The differences in baseline characteristics between the three groups of patients were not statistically significant(p> 0.05)and were comparable.(2)The fasting blood glucose in group A patients gradually decreased from(8.73 ± 2.21)mmol / L before surgery to(6.02 ± 0.82)mmol / L at 6 months after surgery.After meals,the blood glucose at 2h decreased from(12.37 ± 2.86)mmol / L before surgery to(7.32 ± 0.83)mmol / L at 6 months after surgery;the FPG and 2h PG of patients in group B also decreased significantly.The previous(8.21 ± 3.04)mmol / L decreased to(5.73 ± 1.54)mmol / L 6 months after the operation,and the 2h PG decreased from(12.21 ± 2.94)mmol / L before the operation to 6 months after the operation(6.95 ± 1.68)mmol / L;FPG and 2h PG of patients in group C were also significantly reduced,and FPG decreased from(8.66 ± 2.27)mmol / L before surgery to(6.06 ± 1.27)mmol / L at 6 months after surgery.2h PG decreased from(12.67 ± 2.27)mmol / L before surgery to(7.06 ± 0.87)mmol / L 6 months after surgery.At 7 days,1 month,3 months,and 6 months,there was no significant difference in FPG and 2h PG between groups A and B(P> 0.05;P> 0.05;P> 0.05;P> 0.05).At 7 days,1 month,3 months,and 6 months after operation,there was no statistical difference in FPG and 2h PG between patients in groups A and C(P> 0.05).P > 0.05;P > 0.05;P > 0.05);there was no comparison between FPG and 2h PG at 7 days,1 month,3 months,and 6 months in patients in groups B and C.Statistical differences(P > 0.05;P > 0.05;P > 0.05;P > 0.05).After surgery,all three groups lost weight.At 7 days,1 month,3 months,and 6 months after operation,there was no significant difference in BMI between patients in group A and group B(P> 0.05;P> 0.05;P> 0.05;P> 0.05).After 7 days,1 month,3 months,and 6 months,there was no comparison of BMI between groups A and C.Statistical differences(P > 0.05;P > 0.05;P > 0.05;P > 0.05);The patients in group B and group C were 7 days after surgery,1 month after surgery,3 months after surgery,and 6 after surgery.month.There was no statistical difference in BMI comparison(P> 0.05;P> 0.05;P> 0.05;P> 0.05).(3)Compared with before surgery,48 of the 52 cases in group A significantly improved,and 4 cases were ineffective,with an effective rate of 92.3%(48/52);31 cases in group B,19 cases were significantly improved,and 12 cases were ineffective.The effective rate was 61.3%(19/31);23 of 44 patients in group C showed significant improvement,and 11 were ineffective.Comparing the three groups,the differences between groups A,B,and C were statistically significant(P <0.01;P <0.01),while the differences between groups B and C were not statistically significant(P = 0.13).At 6 months after surgery,the effectiveness of diabetes control was better in group A than in group B and group C.(4)The effect of blood glucose control in the 6th month after Roux-en-Y was independent of gender,age,and preoperative fasting blood glucose level,but was related to preoperative BMI and disease duration.Conclusions: In the case of lowering the insulin dose,reducing the type of hypoglycemic drugs and lowering the dose,the blood glucose decreased and the BMI also decreased,which indicates that Roux-en-Y surgery plays an important role in reducing blood glucose.Patients with early gastric cancer are better at controlling diabetes.For patients with gastric cancer and T2 DM,surgery should be performed as soon as possible to obtain the best results.The effect of blood glucose control at 6 months after Roux-en-Y anastomosis has nothing to do with gender,age,and preoperative fasting blood glucose level,and it is related to preoperative BMI and course of disease. |
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