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三角吻合术对胃癌伴T2DM患者全腹腔镜远端胃切除术后糖代谢的影响
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
- 第三军医大学学报 2019年41卷第12期 页码：1174-1180
- 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：
[鲍传庆，E-mail：bcq_wxsy@163.com BAO Chuanqing, E-mail: bcq_wxsy@163.com
- 基金信息：江苏省无锡市卫生计生委科研项目面上项目(MS201612)
DOI：10.16016/j.1000-5404.201811219
中图分类号： Q591.4;R587.1;R656.61收稿：2018-11-29，
修回：2019-01-28，
纸质出版：2019-06-30
- 稿件说明：
移动端阅览
杨增辉, 鲍传庆, 许炳华, 等. 三角吻合术对胃癌伴T2DM患者全腹腔镜远端胃切除术后糖代谢的影响[J]. 第三军医大学学报, 2019,41(12):1174-1180.
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.
杨增辉, 鲍传庆, 许炳华, 等. 三角吻合术对胃癌伴T2DM患者全腹腔镜远端胃切除术后糖代谢的影响[J]. 第三军医大学学报, 2019,41(12):1174-1180. DOI： 10.16016/j.1000-5404.201811219.
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
2
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
2
将90例行TLDG的胃癌伴T2DM患者分为观察组(
n
=36)与对照组(
n
=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
2
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(
P
<
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(
P
<
0.05)，而网模素-1、脂联素水平显著高于对照组(
P
<
0.05)。
结论
2
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
2
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
2
Ninety patients with T2DM undergoing TLDG for gastric cancer were divided based on the patients' preference and surgical indications into delta-shaped anastomosis group (
n
=36) and Billroth-Ⅰ digestive tract reconstruction group (control group
n
=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
3
and 6 months af
ter the surgery.
Results
2
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 (
P
<
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 (
P
<
0.05) and the serum levels of omentin-1 and adiponectin were significantly higher in delta-shaped anastomosis group than in the control group (
P
<
0.05).
Conclusion
2
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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