Choice of Digestive Tract Reconstruction to Gastric Antral Cancer Patients with Type 2 Diabetes_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 LIU Gao ¹ , WANG Kangtai ¹ , ZHANG Bitao ¹ , XIANG Tian ² , WU Quanfeng ¹

1.Department of Gastrointestinal Surgery， Central Hospital of Enshi Prefecture， Enshi 445000， Hubei Province， China;;
2.Department of Clinical Laborotary Center， Central Hospital of Enshi Prefecture， Enshi 445000， Hubei Province， China;

Corresponding author：

LIU Gao, Email: lgkinki@163.com

Keywords：

Gastric antral cancer; Type 2 diabetes; Blood glucose; Digestive tract reconstruction

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Objective 　To assess the influence of different digestive tract reconstruction on the blood glucose of gastric antral cancer patients with type 2 diabetes.
Methods 　The clinical data of 51 cases of gastric antral cancer with type 2 diabetes treated radical surgery in this hospital from January 2006 to January 2012 were analyzed retrospectively. The patients were divided into three groups according to the different digestive tract reconstruction methods：BillrothⅠ anastomosis group （n=14）， BillrothⅡ anastomosis group （n=28）， and Roux-en-Y anastomosis group （n=9）. The indexes were analyzed and compared among three groups：① The levels of fast blood glucose （FBG） and 2h postprandial blood glucose （PG2h） were detected before operation and on 1 month and 6 months after the operation；② The level of glycated hemoglobin （HbA1c） was detected before operation and 6 months after the operation；③ The diabetes control was observed.
Results 　The FBG and PG2h levels in the BillrothⅠ anastomosis group detected on 1 month and 6 months after the operation were not statistically different from those detected before the operation （P＞0.05）. The FBG and PG2h levels in the BillrothⅡanastomosis group and Roux-en-Y anastomosis group detected on 1 month and 6 months after the operation were significantly lower than those before the operation respectively （P＜0.05）. The FBG and PG2h levels in the BillrothⅡ anastomosis group detected on 1 month and 6 months after the operation were not statistically different from those in the Roux-en-Y anastomosis group respectively （P＞0.05）， but which were markedly lower than those in the BillrothⅠ anastomosis group， the differences were statistically significant （P＜0.05）. The HbA1c levels in the BillrothⅠ anastomosis group detected before the operation and on 6 months after the operation were not statistically different from each other （P＞0.05）. The HbA1c levels in the BillrothⅡ anastomosis group and Roux-en-Y anastomosis group detected on 6 months after the operation were markedly lower than those before the operation and the difference was statistically significant （P＜0.05）. On 6 months after the operation， the HbA1c levels in the BillrothⅡanastomosis group and Roux-en-Y anastomosis group were markedly lower than those in the BillrothⅠ anastomosis group and the differences were statistically significant （P＜0.05）；the HbA1c level was not statistically different between the BillrothⅡ anastomosis group and the Roux-en-Y anastomosis group （P＞0.05）. The total curative effects in the BillrothⅡ anastomosis and Roux-en-Y anastomosis groups were significantly better than those in the BillrothⅠ anastomosis group （P＜0.05）.
Conclusion 　According to our limited clinical data， BillrothⅡ anastomosis and Roux-en-Y anastomosis for gastric antral cancer patients with type 2 diabetes may be the best surgical approach.

Citation： LIU Gao,WANG Kangtai,ZHANG Bitao,XIANG Tian,WU Quanfeng. Choice of Digestive Tract Reconstruction to Gastric Antral Cancer Patients with Type 2 Diabetes. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2013, 20(2): 199-203. doi: Copy

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14.	Holdstock C， Lind L， Engstrom BE， et al. CRP reduction following gastric bypass surgery is most pronounced in insulin-sensitive subjects[J]. Int J Obes (Lond)， 2005， 29(10)：1275-1280.
15.	Utzschneider KM， Trence DL. Effectiveness of gastric bypass surgery in a patient with familial partial lipodystrophy[J]. Diabetes Care， 2006， 29(6)：1380-1382.
16.	Kashyap SR， Daud S， Kelly KR， et al. Acute effects of gastric bypass versus gastric restrictive surgery on beta-cell function and insulinotropic hormones in severely obese patients with type 2 diabetes[J]. Int J Obes， 2010， 34(3)：462-471.
17.	刘洋，田晓峰. 2型糖尿病手术治疗机制的研究进展[J]. 大连医科大学学报， 2011， 33(6)：611-616.
18.	Garcia-Fuentes E， Garrido-Sanchez L， Garcia-Almeida JM， et al. Different effect of laparoscopic Roux-en-Y gastric bypass and open biliopancreatic diversion of scopinaro on serum PYY and ghrelin levels[J]. Obes Surg， 2008， 18(11)：1424-1429.
19.	Gumbs AA， Modlin IM， Ballantyne GH. Changes in insulinresistance following bariatric surgery：role of caloric restriction and weight loss[J]. Obes Surg， 2005， 15(4)：462-473.
20.	Couzin J. Medicine. Bypassing medicine to treat diabetes[J]. Science， 2008， 320(5875)：438-440.
21.	Aylwin S. Gastrointestinal surgery and gut hormones[J]. Gastrointest Horm， 2005， 12(1)：89-98.
22.	李威杰. 全球手术治疗糖尿病最新进展[J]. 中国实用外科杂志， 2010， 30(7)：571-573.
23.	Rubino F， Forgione A， Cummings DE， et al. The mechanism of diabetes control after gastrointestinal bypass surgery reveals a role of the proximal small intestine in the pathophysiology of type 2 diabetes[J]. Ann Surg， 2006， 244(5)：741-749.
24.	杨洪范，陈达琨. 胃转流术后2型糖尿病恢复的分子机制研究进展[J]. 医学综述， 2012， 18(5)：744-746.

1. Yang W， Lu J， Weng J， et al. Prevalence of diabetes among men and women in China[J]. N Engl J Med， 2010， 362(12)：1090-1101.
2. Flatt PR， Day C， Bailey CJ. Bariatric surgery：to treat diabesity[J]. Br J Diabetes Vasc Dis， 2009， 9(3)：103-107.
3. 李红金，赵敏，綦雯雯，等. 2010美国糖尿病协会糖尿病治疗指南[J]. 中国卒中杂志， 2011， 6(4)：316-324.
4. American Diabetes Association. Diagnosis and classification of diabetes mellitus[J]. Diabetes Care， 2012， 35 Suppl 1 (Suppl 1)：S64-S71.
5. 谢锦桃，刘军，伍远征，等. 2011年美国糖尿病协会糖尿病诊疗标准执行纲要解读[J]. 中国全科医学， 2011， 14(18)：1993-1997.
6. 张永成，谢庆. 毕Ⅱ式手术对胃癌合并糖尿病患者远期血糖变化的影响[J]. 浙江实用医学， 2009， 14(6)：484， 503.
7. Forgács S， Halmos T. Improvement of glucose tolerance in diabetics following gastrectomy[J]. Z Gastroenterol， 1973， 11(4)：293-296.
8. 王跃生，史逸华，陈福军. 胃转流术对2型糖尿病大鼠空腹血糖的影响及其机理[J]. 中国普外基础与临床杂志， 2011， 18(8)：849-853.
9. 邓治洲，王烈，林忆阳，等. 胃转流术对非肥胖型2型糖尿病的疗效观察及其对胰高血糖素样肽-1的影响[J]. 中国普外基础与临床杂志， 2009， 16(6)：466-469.
10. Lee WJ， Wang W， Lee YC， et al. Effect of laparoscopic mini-gastric bypass for type 2 diabetes mellitus：comparison of BMI＞35 and ＜35 kg/m2[J]. J Gastrointest Surg， 2008， 12(5)：945-952.
11. 张国新，杨学军，徐红，等. 胃旁路手术治疗Ⅱ型糖尿病的体会[J]. 中华普通外科杂志， 2005， 4(5)：599.
12. Iglesias P， Díez JJ. Influence of thyroid dysfunction on serum concentrations of adipocytokines[J]. Cytokine， 2007， 40(2)：61-70.
13. Ferchak CV， Meneghini LF. Obesity， bariatric surgery and type 2 diabetes——a systematic review[J]. Diabetes Metab Res Rev， 2004， 20(6)：438-445.
14. Holdstock C， Lind L， Engstrom BE， et al. CRP reduction following gastric bypass surgery is most pronounced in insulin-sensitive subjects[J]. Int J Obes (Lond)， 2005， 29(10)：1275-1280.
15. Utzschneider KM， Trence DL. Effectiveness of gastric bypass surgery in a patient with familial partial lipodystrophy[J]. Diabetes Care， 2006， 29(6)：1380-1382.
16. Kashyap SR， Daud S， Kelly KR， et al. Acute effects of gastric bypass versus gastric restrictive surgery on beta-cell function and insulinotropic hormones in severely obese patients with type 2 diabetes[J]. Int J Obes， 2010， 34(3)：462-471.
17. 刘洋，田晓峰. 2型糖尿病手术治疗机制的研究进展[J]. 大连医科大学学报， 2011， 33(6)：611-616.
18. Garcia-Fuentes E， Garrido-Sanchez L， Garcia-Almeida JM， et al. Different effect of laparoscopic Roux-en-Y gastric bypass and open biliopancreatic diversion of scopinaro on serum PYY and ghrelin levels[J]. Obes Surg， 2008， 18(11)：1424-1429.
19. Gumbs AA， Modlin IM， Ballantyne GH. Changes in insulinresistance following bariatric surgery：role of caloric restriction and weight loss[J]. Obes Surg， 2005， 15(4)：462-473.
20. Couzin J. Medicine. Bypassing medicine to treat diabetes[J]. Science， 2008， 320(5875)：438-440.
21. Aylwin S. Gastrointestinal surgery and gut hormones[J]. Gastrointest Horm， 2005， 12(1)：89-98.
22. 李威杰. 全球手术治疗糖尿病最新进展[J]. 中国实用外科杂志， 2010， 30(7)：571-573.
23. Rubino F， Forgione A， Cummings DE， et al. The mechanism of diabetes control after gastrointestinal bypass surgery reveals a role of the proximal small intestine in the pathophysiology of type 2 diabetes[J]. Ann Surg， 2006， 244(5)：741-749.
24. 杨洪范，陈达琨. 胃转流术后2型糖尿病恢复的分子机制研究进展[J]. 医学综述， 2012， 18(5)：744-746.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Choice of Digestive Tract Reconstruction to Gastric Antral Cancer Patients with Type 2 Diabetes

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