Kim Ji Won, Kim Kwang Yong, Lee Seung Chul, Yang Dae Hyun, Kim Byung Chun
Department of Surgery, Hallym University Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea.
Ann Surg Treat Res. 2015 Apr;88(4):215-21. doi: 10.4174/astr.2015.88.4.215. Epub 2015 Mar 26.
We applied a long Roux-en-Y (RY) gastrojejunostomy (bypassed jejunum over 100 cm) as a reconstruction method for diabetes control to gastric cancer patients with type 2 diabetes and body mass index (BMI) < 35 kg/m(2). The effect of this procedure on diabetes control was assessed.
We prospectively performed modified RY gastrojejunostmy after curative radical distal gastrectomy. Thirty patients had completed a 1-year follow-up. Patients were followed concerning their diabetic status. The factors included in the investigation were length of bypassed jejunum, BMI and its reduction ratio, glycated hemoglobin (HbA1c), fasting blood glucose, and duration of diabetes. Diabetic status after surgery was assessed in three categories: remission, improvement, and stationary. In evaluation of surgical effects on diabetes control, remission and improvement groups were regarded as effective groups, while stationary was regarded as an ineffective group.
At postoperative one year, statistical significance was observed in the mean BMI and HbA1c. Diabetes control was achieved in 50% of the patients (remission, 30%; improvement, 20%). BMI reduction ratio, preoperative HbA1c, and duration of diabetes were correlated to the status of type 2 diabetes mellitus. The preoperative HbA1c was the most influential predictor in diabetic control.
The effect of long RY gastrojejunostomy after gastrectomy for diabetes control could be contentious but an applicable reconstruction method for diabetes control in gastric cancer patients with type 2 diabetes and BMI < 35 kg/m(2). Diabetes remission is expected to be higher in patients with greater BMI reduction, short duration of diabetes, and lower preoperative HbA1c.
我们采用长袢Roux-en-Y（RY）胃空肠吻合术（旷置空肠超过100 cm）作为一种控制糖尿病的重建方法，应用于2型糖尿病且体重指数（BMI）<35 kg/m²的胃癌患者。评估该手术对糖尿病控制的效果。
我们在根治性远端胃切除术后前瞻性地实施改良RY胃空肠吻合术。30例患者完成了1年的随访。对患者的糖尿病状况进行随访。调查中纳入的因素包括旷置空肠的长度、BMI及其降低率、糖化血红蛋白（HbA1c）、空腹血糖和糖尿病病程。术后糖尿病状况分为三类进行评估：缓解、改善和稳定。在评估手术对糖尿病控制的效果时，缓解组和改善组被视为有效组，而稳定组被视为无效组。
术后1年，平均BMI和HbA1c有统计学意义。50%的患者实现了糖尿病控制（缓解，30%；改善，20%）。BMI降低率、术前HbA1c和糖尿病病程与2型糖尿病状况相关。术前HbA1c是糖尿病控制中最具影响力的预测指标。
胃切除术后长袢RY胃空肠吻合术对糖尿病控制的效果可能存在争议，但对于2型糖尿病且BMI<35 kg/m²的胃癌患者而言，是一种可应用的糖尿病控制重建方法。预计BMI降低幅度更大、糖尿病病程较短且术前HbA1c较低的患者糖尿病缓解率更高。
