胃肠道转流对合并糖尿病胃癌患者糖代谢的影响研究(1)
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[摘要] 目的：探讨胃肠道转流对合并糖尿病的胃癌患者糖代谢的影响。方法：选择68例合并2型糖尿病的胃癌患者作为研究对象，均接受肿瘤根治性切除及胃肠道转流手术，观察术后糖代谢变化及胰岛素第一分泌时相变化。结果：术后1个月FPG、2hPG水平下降，术后6个月及术后12个月接近正常，患者术后1周胰岛素分泌峰值提前，第一时相胰岛素净分泌量增加，术后6个月及12个月，胰岛素分泌峰值提前及第一时相胰岛素净分泌量增加更为明显。结论：胃肠道转流能够影响合并2型糖尿病胃癌患者的糖代谢，其可能同胰岛素分泌变化有关。
[关键词] 胃肠道转流；胃癌；2型糖尿病；胰岛素
[中图分类号] R735.2 [文献标识码] A [文章编号] 1674-4721(2011)11(c)-005-03
Effects of gastric-bowel bypass to glycometabolism on gastric cancer with 2 diabetic
HU Yuhui
Department of General Surgery, Renshou People's Hospital in Sichuan Province, Renshou 620500, China
[Abstract] Objective: To investigate the effect of gastric-bowel bypass to glycometabolism on patients with gastric cancer combined 2 diabetic (2DM). Methods: 68 cases of patients with gastric cancer combined 2DM were selected as research object and taken gastric cancer radical excision and gastric-bowel bypass, observed the change of glycometabolism and first secretion pases of insulin after operation. Results: One month after operations, fasting plasma glucose (FPG), and 2hPG was lower, the level of FPG and 2hPG were intimate to normal level in 6 and 12 month after operations, one week after operations, peak of insulin advanced and secretory volume of insulin in first secretion pases was increasing, along time lenthing, peak of insulin advanced and secretory volume of insulin was more apparente. Conclusion: Gastric-bowel bypass has effect in glycometabolism on patients with gastric cancer combined 2 diabetic, that maybe is result of change in insulin secretion.
[Key words] Gastric bypass; Gastric cancer; 2 diabetic; Insulin
胰岛素抵抗及胰岛素分泌相对不足是2型糖尿病的基本发病机制，胰岛素的分泌受多种胃肠道激素的影响，胃肠道转流能够改变食物的消化途径，对胃肠道激素的分泌存在明显的影响，其可能对合并2型糖尿病的胃肠道疾病患者的糖代谢产生影响[1]，本文就合并2型糖尿病的胃癌患者胃肠道转流术后糖代谢及其影响因素进行探讨。
1 资料与方法
1.1 一般资料
选择本院2003年1月~2010年5月收治的合并2型糖尿病的胃癌患者68例，其中，男38例，女30例，年龄47~72岁，平均(58±13.6)岁，其中Ⅱ期胃癌患者29例，Ⅲ期胃癌患者39例，并排除预期术后存活不能超过12个月患者，患者胃癌均经胃镜病理诊断，糖尿病诊断符合WHO 1999年提出的2型糖尿病诊断标准，糖尿病病程0~11年，平均(4.2±3.6)年，其中合并眼底、周围神经或心血管并发症11例，胰岛素治疗24例，口服药物治疗38例，未治疗6例。
1.2 手术方法
患者术前常规检查及消化道准备，血糖控制平稳后手术治疗，均经开放式手术行D2胃癌根治术，术中常规切除及清扫淋巴结，其中远端胃大部切除44例，近端胃大部切除24例，行毕Ⅰ式胃空肠吻合21例，胃食道吻合8例，毕Ⅱ式胃空肠吻合39例，患者均手术顺利，术后无出血、吻合口漏等严重并发症发生，术后均采取胰岛素控制血糖，术后恢复过程均顺利。
1.3 观察指标
观察患者术前和术后1周、1个月、6个月及12个月 FPG、2hPG及第一时相胰岛素分泌变化。
1.4 指标检测方法
患者FPG、2hPG分别于患者空腹状态及餐后2 h采集静脉血检测 ......
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