Effect of delta-shaped anastomosis in digestive tract reconstruction on glucose metabolism in type 2 diabetic patients following total laparoscopic distal gastrectomy for gastric cancer

Zenghui YANG; Chuanqing BAO; Binghua XU; Xiaoming SHEN; Yifan SHI; Tiantian ZHAO; Bo LIU; Sen GAO

doi:10.16016/j.1000-5404.201811219

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Effect of delta-shaped anastomosis in digestive tract reconstruction on glucose metabolism in type 2 diabetic patients following total laparoscopic distal gastrectomy for gastric cancer

Clinical Medicine | 更新时间：2026-01-09

- Effect of delta-shaped anastomosis in digestive tract reconstruction on glucose metabolism in type 2 diabetic patients following total laparoscopic distal gastrectomy for gastric cancer
- Journal of Third Military Medical University Vol. 41, Issue 12, Pages: 1174-1180(2019)
- 作者机构：
  
  214041 江苏无锡，无锡市第三人民医院胃肠外科
- 作者简介：
- 基金信息：
  
  Supported by the General Program of Science Research of Wuxi Health and Family Planning Commission(MS201612)
- DOI：10.16016/j.1000-5404.201811219
  CLC： Q591.4;R587.1;R656.61
- Received：29 November 2018，
  
  Revised：2019-01-28，
  
  Published：30 June 2019
- 稿件说明：
移动端阅览
Zenghui YANG, Chuanqing BAO, Binghua XU, et al. Effect of delta-shaped anastomosis in digestive tract reconstruction on glucose metabolism in type 2 diabetic patients following total laparoscopic distal gastrectomy for gastric cancer[J]. Journal of Third Military Medical University, 2019, 41(12): 1174-1180.
DOI：

Zenghui YANG, Chuanqing BAO, Binghua XU, et al. Effect of delta-shaped anastomosis in digestive tract reconstruction on glucose metabolism in type 2 diabetic patients following total laparoscopic distal gastrectomy for gastric cancer[J]. Journal of Third Military Medical University, 2019, 41(12): 1174-1180. DOI： 10.16016/j.1000-5404.201811219.

摘要

目的

探讨全腹腔镜远端胃切除术(total laparoscopic distal gastrectomy，TLDG)后行三角吻合消化道重建对胃癌合并2型糖尿病(T2DM)患者糖代谢的影响。

方法

将90例行TLDG的胃癌伴T2DM患者分为观察组(

=36)与对照组(

=54)，观察组行三角吻合术，对照组行Billroth-Ⅰ式吻合。比较两组围手术期情况，术前及术后1、3、6个月测定体质量指数(BMI)、胰岛素用量、空腹血糖(FPG)、餐后2 h血糖(2hPG)、糖化血红蛋白(HbAlc)、血清肿瘤坏死因子α(TNF-α)、白介素-6(IL-6)、网模素-1(omentin-1)、脂联素(adiponectin)、抑胃肽(gastric inhibitory peptide

GIP)、胰高血糖素样肽-1(glucagon-like peptide-1

GLP-1)及GIP/GLP-1。

结果

观察组的切口长度、手术时间、术中出血量、术后排气时间及住院时间均显著低于对照组(

0.05)。术后1、3、6个月，观察组的BMI、FPG、2hPG、HbAlc和血清TNF-α、IL-6、GIP、GIP/GLP-1水平均显著低于对照组(

0.05)，而网模素-1、脂联素水平显著高于对照组(

0.05)。

结论

胃癌伴T2DM患者行TLDG联合三角吻合消化道重建安全可行，较经典Billroth-Ⅰ式吻合更有利于改善术后糖代谢状态。

Abstract

Objective

To investigate the effect of delta-shaped anastomosis in digestive tract reconstruction on postoperative glucose metabolism in patients with type 2 diabetes mellitus (T2DM) following total laparoscopic distal gastrectomy (TLDG) for gastric cancer.

Methods

Ninety patients with T2DM undergoing TLDG for gastric cancer were divided based on the patients' preference and surgical indications into delta-shaped anastomosis group (

=36) and Billroth-Ⅰ digestive tract reconstruction group (control group

=54). The surgical and perioperative data including body mass index (BMI)

insulin dosage

fasting plasma glucose (FPG)

postprandial 2 h plasma glucose (2hPG)

glycosylated hemoglobin (HbAlc)

serum levels of tumor necrosis factor-α (TNF-α)

interleukin-6 (IL-6)

omentin-1

adiponectin

gastric inhibitory peptide (GIP) and glucagon-like peptide-1 (GLP-1)

and GIP/GLP-1 ratio were compared between the 2 groups before and at 1

and 6 months af

ter the surgery.

Results

The incision length

operation time

intraoperative blood loss

the time of first bowel movement and hospital stay were significantly shorter or less in delta-shaped anastomosis group than in the control group (

0.05). At 1

3 and 6 months after the surgery

BMI

FPG

2hPG

HbAlc

serum levels of TNF-α

IL-6 and GIP and GIP/GLP-1 ratio were significantly lower (

0.05) and the serum levels of omentin-1 and adiponectin were significantly higher in delta-shaped anastomosis group than in the control group (

0.05).

Conclusion

In type 2 diabetic patients with gastric cancer

TLDG combined with delta-shaped anastomosis in digestive tract reconstruction is safe and feasible and better improves postoperative glucose metabolism of the patients than classic Billroth-Ⅰ anastomosis.

关键词

Keywords

references

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