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胃癌患者胃切除术后 Roux-en-Y 吻合术真的能带来 2 型糖尿病缓解的益处吗?一项系统评价和荟萃分析。

Does Roux-en-Y Construction Really Bring Benefit of Type 2 Diabetes Mellitus Remission After Gastrectomy in Patients with Gastric Cancer? A Systematic Review and Meta-Analysis.

作者信息

Peng Dong, Cheng Yu-Xi, Zhang Wei

机构信息

Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.

出版信息

Diabetes Ther. 2020 Dec;11(12):2863-2872. doi: 10.1007/s13300-020-00934-7. Epub 2020 Oct 1.

Abstract

INTRODUCTION

To evaluate whether the extent of gastrectomy or the reconstruction method brings benefit of type 2 diabetes mellitus (T2DM) remission after gastrectomy in patients with gastric cancer.

METHODS

PUBMED, EMBASE, the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library were searched to find eligible studies published from inception to July 31, 2020.

RESULTS

A total of nine studies (1424 patients) were included. At the first year and the end of follow-up time after gastrectomy, the total gastrectomy group had better T2DM remission than the subtotal gastrectomy group, and the Roux-en-Y reconstruction (R-Y) group had better T2DM remission compared with the non-R-Y group. There was no difference between R-Y and non-R-Y in terms of subtotal gastrectomy (OR 1.08, 95% CI 0.63-1.84, P = 0.78). However, total gastrectomy with R-Y had better T2DM remission than subtotal gastrectomy with R-Y (OR 2.75, 95% CI 1.19-6.35, P = 0.02).

CONCLUSION

Total gastrectomy with R-Y had better T2DM remission. The extent of gastrectomy rather than the reconstruction method might play an important role in T2DM remission after gastrectomy in patients with gastric cancer.

摘要

引言

评估胃癌患者胃切除范围或重建方法是否能使胃切除术后2型糖尿病(T2DM)缓解受益。

方法

检索了PUBMED、EMBASE以及Cochrane图书馆中的Cochrane对照试验中心注册库(CENTRAL),以查找从创刊至2020年7月31日发表的符合条件的研究。

结果

共纳入9项研究(1424例患者)。在胃切除术后第1年和随访期末,全胃切除组的T2DM缓解情况优于胃大部切除组,Roux-en-Y重建(R-Y)组的T2DM缓解情况优于非R-Y组。胃大部切除时,R-Y与非R-Y之间无差异(比值比[OR]1.08,95%置信区间[CI]0.63-1.84,P = 0.78)。然而,R-Y全胃切除术的T2DM缓解情况优于R-Y胃大部切除术(OR 2.75,95%CI 1.19-6.35,P = 0.02)。

结论

R-Y全胃切除术的T2DM缓解效果更好。胃切除范围而非重建方法可能在胃癌患者胃切除术后T2DM缓解中起重要作用。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b512/7644734/327c2c6b418a/13300_2020_934_Fig1_HTML.jpg

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