Ye Zai-Yuan, Zhang Wei, Zhang Qin, Dai Qiao-Qiong, Shao Qin-Shu, Sun Yuan-Shui, Wang Yuan-Yu
Department of Gastrointestinal Surgery, Zhejiang Provincial People's Hospital, Hangzhou 310014, China.
Zhonghua Wei Chang Wai Ke Za Zhi. 2011 Mar;14(3):210-2.
To evaluate the impact of reconstruction techniques after subtotal gastrectomy on postoperative glucose and insulin levels after oral glucose tolerance test (OGTT).
Distal gastrectomy was performed in 38 Beagle dogs. Reconstruction techniques used included integral continual jejunal interposition (n=9), Billroth I( (n=6), Billroth II( (n=7), and isolated jejunal interposition (n=8). Eight controls were used. OGTT was conducted to examine the changes in glucose and insulin levels.
Compared to controls, glucose significantly increased in all the 4 operative groups and peaked at 60 min. Billroth II( was associated with the most significant increase. Insulin level significantly increased in all the experimental groups in response to food stimulus and peaked at 60 min. However, the increase of insulin in Billroth II( group was not as prominent as in other groups.
Fluctuation of blood glucose after gastrectomy may be mitigated and insulin elevated if duodenal passage is preserved. Continual jejunal interposition should be given priority when Billroth I( reconstruction is not feasible.
评估胃大部切除术后重建技术对口服葡萄糖耐量试验(OGTT)后术后血糖和胰岛素水平的影响。
对38只比格犬实施远端胃切除术。采用的重建技术包括完整连续空肠间置术(n = 9)、毕罗Ⅰ式(n = 6)、毕罗Ⅱ式(n = 7)和孤立空肠间置术(n = 8)。设置8只对照犬。进行OGTT以检测血糖和胰岛素水平的变化。
与对照组相比,所有4个手术组的血糖均显著升高,并在60分钟时达到峰值。毕罗Ⅱ式组的血糖升高最为显著。所有实验组的胰岛素水平在食物刺激后均显著升高,并在60分钟时达到峰值。然而,毕罗Ⅱ式组胰岛素的升高不如其他组明显。
如果保留十二指肠通道,胃切除术后血糖波动可能会减轻,胰岛素水平会升高。当毕罗Ⅰ式重建不可行时,应优先选择连续空肠间置术。