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目的:探讨根治性远侧胃切除术中不同的吻合方式对胃癌合并2型糖尿病患者术后血糖的影响。方法:回顾我院64例胃癌合并2型糖尿病患者,行根治性远侧胃切除术,按吻合方式不同,分为3组,毕Ⅰ式吻合22例(A组),毕Ⅱ式+空肠侧侧吻合20例(B组),Roux-en-Y吻合22例(C组),分析比较此3组患者术前术后空腹血糖变化及糖尿病控制情况。结果:3组患者术后空腹血糖均有下降,且术前术后比较差异有统计学意义(P<0.05),同A组相比,B组、C组术后1周、术后1月、术后6月空腹血糖均有下降,差异有统计学意义(P<0.05)。与A组相比,B组和C组中糖尿病治愈例数较多,而无效例数较少,差异有统计学意义(P<0.05)。结论:毕Ⅱ式+空肠侧侧吻合、残胃空肠Roux-en-Y吻合方式可能改善2型糖尿病患者的空腹血糖水平,可成为该类患者的首选吻合方式。
Objective: To investigate the effect of different modes of anastomosis on the postoperative blood glucose in patients with gastric cancer complicated with type 2 diabetes mellitus. Methods: A retrospective study of 64 cases of gastric cancer with type 2 diabetes mellitus in our hospital, undergoing radical distal gastrectomy, according to different anastomosis, divided into 3 groups, complete Ⅰ Ⅰ anastomosis in 22 cases (group A), complete Ⅱ + jejunum side 20 cases (group B) and Roux-en-Y anastomosis in 22 cases (group C). The changes of fasting blood glucose and the control of diabetes in these three groups were analyzed and compared. Results: The fasting blood glucose of the three groups decreased after operation, and the difference was statistically significant before and after operation (P <0.05). Compared with the A group, the B group and C group one week after operation and one month after operation , And the fasting blood glucose decreased in June after operation, the difference was statistically significant (P <0.05). Compared with group A, there were more cases of diabetes mellitus cure in group B and group C, while the number of invalid cases was less, with significant difference (P <0.05). CONCLUSION: Bi Ⅱ + jejunal lateral anastomosis and Roux-en-Y gastric anastomosis may improve fasting blood glucose level in patients with type 2 diabetes, which may be the first choice of anastomosis in these patients.