ABSTRACT
Objective To explore the influence of alimentary tract reconstruction after gastrectomy on the blood glucose level in patients with gastric cancers combined with type 2 diabetes mellitus. Methods From January 2004 to December 2009, the level of blood glucose and body weight before operation and 1,3,6 months after operation in 87 gastric cancer combined with type 2 diabetes mellims patients were retrospectively analyzed. These patients underwent different alimentary tract reconstructions,including 48 patients for Billroth I after distal subtotal gastrectomy (group A), 39 patients for esophageal Roux-en-Y jejunostomy after total gastrectomy (group B). Fasting blood glucose (FBG) level and body weight of these patients were compared. Results In group A, change of FBG before and after operation were not significant (P ＞ 0.05 ). The levels of FBG in group B were significantly lower in 1,3,6 months after operation [(6.7 ±0.8), (6.6 ±0.6), (6.8 ±0.7) mmol/L] than that before operation [(9.7 ± 1.4) mmol/L](P＜0.05). The lower value average difference of FBG at 1,3,6 months was significant between group A and group B (P＜0.05 ). In group B, 6 months after operation's total effective rate was 87.2% (34/39). Changes of body weight before and after operation in group A and group B were significant (P ＜ 0.05 ). But between two groups, the changes of body weight between 1,3,6 months and before operation were not significant (P ＞0.05).Conclusions Esophageal Roux-en-Y jejunostomy after total gastrectomy has obvious influence on FBG level in patients with gastric cancers combined with type 2 diabetes mellitus. It takes about 1 month to reveal the effect of operation and has nothing to do with weight loss.
ABSTRACT
To resolve the agastric syndrome after total gastrectomy, researchers have performed varoius alimentary tract reconstruction procedures for patients. Meanwhile, because of controversial standpoints fol-lowing the total gastrectomy, more than eighty methods were published in the world. The highlight is focused on the discussion of whether a reservoir with the duodenal passage of foodstuff significantly beneficial to the patient's clinical and nutritional status after total gastrectomy. In this article, we reviewed and evaluated the progress of digestive tract reconstruction procedures after total gastrectomy in order to obtain a optimal opera-tion approach.
ABSTRACT
Objective To explore the influence of alimentary tract reconstruction on blood glucose level in gastric cancer patients complicated with type 2 diabetes mellitus. Methods Clinical data of 67 gastric cancer patients complicated with type 2 diabetes mellitus and the level of blood glucose before operation, one month, three month, six month after operation were retrospectively analyzed. BMI of 53 patients was lower than 25kg/m2,9 patients between 25～29.9 kg/m2 and 5 patients was higher than 30kg/m2 .Total gastrectomy with P-type jejunal pouch Roux-en-Y esophagojejunostomy was performed in 26 cases, and total gastrectomy with Roux-en-Y esophagojejunostomy was performed in 11 cases, distal subtotal gastrectomy with Roux-en-Y gastrojejunostomy in 30 cases. Results Operations on sixty-seven patients were all uneventfully. The mean fasting blood glucose level in the morning was 9.6±3.3 mmol/L before operation, 7.4±2.6 mmol/L one month after operation, 7.5±2.3 mmol/L three month after operation, and 7.7±2.9 mmol/L six month after operation. There were significant differences between the blood glucose level of before operation and one month after operation (P0.05). Conclusions Alimentary tract reconstruction has obviousinfluence on blood glucose level in type 2 diabetes mellitus patients. It takes about one month for reveal the effect of operation. This phenomenon is of value for clinical application. Its mechanism needs further research.
ABSTRACT
Objective To research the effect of alimentary tract reconstruction after gastrectomy on the treatment of type 2 diabetes mellitus(non-insulin-dependent diabetes mellitus, NIDDM). Methods From January 2005 to January 2008, perioperative blood glucose level and insulin therapy in 24 gastric cancer or periampullary carcinoma patients with non-obesity type 2 diabetes were retrospectively analyzed. These patients underwent different alimentary tract reconstruction, including 8 patients for Billroth I, 10 for standard Whipples operation, 6 for esophageal Roux-en-Y jejunostomy after total gastrectomy. Glucose level and insulin dosage of thease patients were compared. Results In the patients underwent Billroth I operation, change of blood glucose level before and after operation was not significant(P＞0.05). The level of blood glucose in patients underwent Whipples operation and total gastrectomy were significant changed 1 and 2 months after the operation (P<0.001). In Billroth I group, 5 patients used insulin to control hyperglycemia preoperatively. After the operation, 2 patents maintained preoperative insulin dosage, 2 had to increase the use of insulin and 1 decreased the insulin dosage. In Whipples group, 6 patients used insulin preoperatively. Interestingly, 4 patents needed less insulin to control hyperglycemia and 2 were free of insulin dependance. In total gastrectomy group, there were 4 patients using insulin to control hyperglycemia. After the operation, 2 patents needed less insulin dosage and 2 stopped using insulin. Conclusions Both Whipples operation and total gastrectomy lead to decreased blood glucose level in NIDDM patients and less need of insulin.The effect of some types of alimentary tract reconstruction after gastrectomy on treatment of type 2 diabetes mellitus is assertive.