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目的:初步探讨毕Ⅱ式吻合和ROUX-en-Y吻合对2型糖尿病(type 2 diabetes mellitus,T2DM)患者胃大部分切除术后糖代谢的影响。方法:选择2011年8月至2014年8月在我院因胃部疾病接受胃大部分切除术且合并T2DM患者116例,按照手术方式分为2组:毕Ⅱ式吻合组(A组:60例)和ROUX-en-Y吻合组(B组:56例),对比2组术前和术后1、3、6个月的空腹血糖(fasting blood glucose,FBG)、餐后2小时血糖(postprandial blood glucose,PBG)、糖化血红蛋白(hemoglobin Alc,Hb Alc)和胰岛素抵抗指数(insulin resistance index,IRI),并评价术后6个月T2DM改善情况。结果:A、B组术后1、3、6月FBG分别为:(7.85±2.04)vs.(7.04±1.93)、(7.75±1.82)vs.(6.84±1.83)、(7.81±1.95)vs.(6.72±1.74);FBG分别为:(12.26±2.30)vs.(11.15±2.28)、(12.12±2.41)vs.(10.74±2.52)、(11.56±2.37)vs.(10.48±2.32);Hb Alc分别为:(7.46±2.56)vs.(7.92±2.40)、(7.61±2.79)vs.(6.67±2.14)、(7.39±1.91)vs.(6.55±2.24);IRI分别为:(6.46±2.29)vs.(5.49±2.35)、(5.86±1.72)vs.(4.44±1.96)、(5.45±1.40)vs.(4.05±1.89)。重复测量方差分析结果显示:FBG、PBG、IRI在不同分组、不同时间以及分组与时间的交互作用均具有统计学意义(P<0.05),Hb Alc仅时间因素具有统计学意义(P<0.05),A组有效率明显低于B组(61.67%vs.78.57%,P<0.05)。结论:毕Ⅱ式和ROUX-en-Y吻合对术后T2DM均有一定改善,ROUX-en-Y吻合疗效更优,具体机制不详,若在临床广泛开展,安全性、可行性有待进一步探索。
Objective: To investigate the effect of Bi Ⅱ anastomosis and ROUX-en-Y anastomosis on glucose metabolism in patients with type 2 diabetes mellitus (T2DM) after partial resection of stomach. Methods: One hundred and sixty-six patients with T2DM who undergone gastric resection due to gastric diseases from August 2011 to August 2014 were selected and divided into two groups according to the surgical procedure: group Ⅱ (group A: 60 (Group B: 56 cases). The fasting blood glucose (FBG), pre-prandial 2-hour postprandial blood glucose postprandial blood glucose (PBG), hemoglobin A1c (Hb Alc) and insulin resistance index (IRI) were measured. The improvement of T2DM at 6 months after operation was evaluated. Results: The FBG in group A and B at 1, 3 and 6 months after operation were (7.85 ± 2.04) vs. (7.04 ± 1.93), (7.75 ± 1.82) vs. (6.84 ± 1.83) vs (7.81 ± 1.95 vs (6.72 ± 1.74), FBG were (12.26 ± 2.30) vs. (11.15 ± 2.28), (12.12 ± 2.41) vs. (10.74 ± 2.52), (11.56 ± 2.37) vs. (10.48 ± 2.32) Hb Alc were (7.46 ± 2.56) vs. (7.92 ± 2.40), (7.61 ± 2.79) vs. (6.67 ± 2.14), (7.39 ± 1.91) vs. (6.55 ± 2.24), respectively ± 2.29 vs. 5.49 ± 2.35, 5.86 ± 1.72 vs. 4.44 ± 1.96, 5.45 ± 1.40 vs. 4.05 ± 1.89, respectively. Repeated measures analysis of variance showed that FBG, PBG and IRI had statistical significance (P <0.05) in different grouping, time and grouping with time (P <0.05), Hb Alc only had significant difference in time (P <0.05) , The effective rate of group A was significantly lower than that of group B (61.67% vs.78.57%, P <0.05). CONCLUSION: Both Bi Ⅱ and ROUX-en-Y anastomosis have a certain improvement on postoperative T2DM, ROUX-en-Y anastomosis is more effective and the specific mechanism is not clear. If it is widely used in clinical practice, its safety and feasibility needs to be further explored.