胃癌合并 2 型糖尿病患者行胃切除术的预后。
Outcome after gastrectomy in gastric cancer patients with type 2 diabetes.
机构信息
Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 135-720, South Korea.
出版信息
World J Gastroenterol. 2012 Jan 7;18(1):49-54. doi: 10.3748/wjg.v18.i1.49.
AIM
To evaluate the prognosis of type II diabetes mellitus (T2DM) after gastrectomy and related factors in gastric cancer patients.
METHODS
403 gastric cancer patients with T2DM were studied, who underwent gastrectomy between May 2003 and September 2009. A review of medical records and telephone interviews was performed in this cross-sectional study. The factors included in the statistical analysis were as follows: gender, age, type of surgery, preoperative body mass index (BMI), current BMI, BMI reduction ratio, preoperative insulin or oral diabetic medicine requirement, follow-up duration, and current state of diabetes. Assessment of diabetes status after surgery was classified into four categories according to the change in hypoglycemic agents after surgery and present status of T2DM: resolution, improvement, same, and worse.
RESULTS
The mean follow-up duration was 33.7 mo (± 20.6 mo), preoperative BMI was 24.7 kg/m(2) (± 3.0 kg/m(2)), and BMI reduction ratio was 9.8% (± 8.6%). After surgery, T2DM was cured in 58 patients (15.1%) and was improved in 117 patients (30.4%). According to the type of surgery, the BMI reduction ratio was significantly higher in the total gastrectomy and Roux-en-Y reconstruction group [14.2% ± 9.2% vs 9.2% ± 7.7% (Billroth II group), P < 0.001] and significantly lower in the subtotal gastrectomy and Billroth I reconstruction group [7.6% ± 8.0%, 9.2% ± 7.7% (Billroth II group), P < 0.001]. The BMI reduction ratio, follow-up duration after surgery, type of surgery, extent of gastrectomy, and performance of duodenal bypass were significantly correlated to the course of T2DM (P < 0.05). The BMI reduction ratio was the most influential factor on T2DM status. In a subgroup analysis of patients with a BMI reduction ratio of 10% or less (n = 206), T2DM was cured in 15 (7.6%) patients and was improved in 57 (28.8%) patients after surgery, and only the duration of surgery was significantly correlated to T2DM status (P = 0.022).
CONCLUSION
The course of T2DM was significantly correlated to the BMI reduction ratio but not to the type of surgery without a significant change in BMI.
目的
评估胃癌患者行胃切除术后 2 型糖尿病（T2DM）的预后及其相关因素。
方法
本研究为回顾性病例对照研究，纳入 2003 年 5 月至 2009 年 9 月间 403 例行胃切除术的 T2DM 胃癌患者。通过病历回顾和电话访谈进行分析。统计分析的因素包括：性别、年龄、手术类型、术前体重指数（BMI）、当前 BMI、BMI 下降率、术前胰岛素或口服降糖药的使用、随访时间以及当前糖尿病状态。根据术后降糖药物的变化和 T2DM 的现状，将术后糖尿病评估分为 4 类：治愈、改善、不变和恶化。
结果
平均随访时间为 33.7 个月（±20.6 个月），术前 BMI 为 24.7kg/m²（±3.0kg/m²），BMI 下降率为 9.8%（±8.6%）。术后，58 例（15.1%）患者 T2DM 治愈，117 例（30.4%）患者 T2DM 改善。根据手术类型，全胃切除术和 Roux-en-Y 重建组的 BMI 下降率显著高于 Billroth II 组[14.2%±9.2%比 9.2%±7.7%（Billroth II 组），P＜0.001]，而全胃切除术和 Roux-en-Y 重建组的 BMI 下降率显著低于 Billroth II 组[7.6%±8.0%，9.2%±7.7%（Billroth II 组），P＜0.001]。BMI 下降率、术后随访时间、手术类型、胃切除范围和十二指肠旁路术与 T2DM 病程显著相关（P＜0.05）。BMI 下降率是影响 T2DM 状态的最主要因素。在 BMI 下降率＜10%的患者亚组分析中（n=206），术后 15 例（7.6%）患者 T2DM 治愈，57 例（28.8%）患者 T2DM 改善，仅手术时间与 T2DM 状态显著相关（P=0.022）。
结论
T2DM 病程与 BMI 下降率显著相关，而与 BMI 无显著变化的手术类型无关。
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