Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea.
Obes Surg. 2012 Aug;22(8):1238-43. doi: 10.1007/s11695-011-0580-1.
This study was conducted to investigate diabetes mellitus (DM) resolution after gastrectomy according to reconstruction type in gastric cancer patients.
Two hundred twenty-nine gastric cancer patients with DM who underwent gastrectomy with curative intent from May 2003 to December 2009 were enrolled. Changes in fasting blood sugar concentration and the dosage of oral hyperglycemic agents or insulin were compared between reconstruction types.
The numbers of patients who underwent distal gastrectomy with a Billroth I (BI), Billroth II (BII), Roux-en-Y gastrojejunostomy (RYGJ), or total gastrectomy with Roux-en-Y esophagojejunostomy (RYEJ) were 119 (51.7%), 54 (23.5%), 40 (17.4%), and 16 (6.9%), respectively. DM remitted in 45 (19.7%) patients: 18 BI patients (15.1%), 11 BII patients (20.3%), 8 RYGJ patients (20.0%), and 8 RYEJ patients (50.0%). DM improved in 85 (37.1%) patients: 41 BI patients (34.4%), 25 BII patients (46.2%), 15 RYGJ patients (37.5%), and 4 RYEJ patients (25.0%). The DM remission or improvement rate was higher in the duodenal bypass group (BII, RYGJ, RYEJ) than in the BI group (67.2% vs. 49.5%, P = 0.022), and the DM remission rate was higher in the RYEJ group than in the distal gastrectomy group (50.0% vs. 17.3%, P = 0.002).
Many gastric cancer patients with DM who received a gastrectomy showed remission or improvement of DM. The duodenal bypass group had higher DM remission or improvement rate than the BI group, and the RYEJ group had the highest DM remission rate.
本研究旨在探讨根据胃癌患者的重建类型，胃切除术后糖尿病（DM）的缓解情况。
纳入 2003 年 5 月至 2009 年 12 月期间接受根治性胃切除术的 229 例合并 DM 的胃癌患者。比较不同重建类型患者空腹血糖浓度变化和口服降糖药或胰岛素剂量。
行远端胃大部切除术（毕Ⅰ式，BI）、毕Ⅱ式（BII）、Roux-en-Y 胃空肠吻合术（RYGJ）和全胃切除术加 Roux-en-Y 食管空肠吻合术（RYEJ）的患者分别为 119 例（51.7%）、54 例（23.5%）、40 例（17.4%）和 16 例（6.9%）。45 例（19.7%）患者 DM 缓解：BI 患者 18 例（15.1%），BII 患者 11 例（20.3%），RYGJ 患者 8 例（20.0%），RYEJ 患者 8 例（50.0%）。85 例（37.1%）患者 DM 改善：BI 患者 41 例（34.4%），BII 患者 25 例（46.2%），RYGJ 患者 15 例（37.5%），RYEJ 患者 4 例（25.0%）。BI 组、RYGJ 组和 RYEJ 组的 DM 缓解或改善率均高于 BI 组（67.2% vs. 49.5%，P=0.022），RYEJ 组的 DM 缓解率高于远端胃切除术组（50.0% vs. 17.3%，P=0.002）。
许多接受胃切除术的合并 DM 的胃癌患者 DM 得到缓解或改善。与 BI 组相比，十二指肠旁路组的 DM 缓解或改善率更高，而 RYEJ 组的 DM 缓解率最高。
