【摘要】   目的  探讨Roux-en-Y吻合重建对胃癌合并T2DM患者血糖水平、胰岛功能及并发症的影响。  方法  根据手术方式将120例I～II期胃癌合并T2DM患者随机分为观察组62例及对照组58例，对照组行胃食管吻合术，观察组行Roux-en-Y吻合重建术，比较两组治疗前后血糖及胰岛素的变化。  结果  术后6个月，观察组BMI[（23.36±2.44）vs（25.33±2.92） kg/m²]、FPG[（5.58±2.02） vs （8.96±1.75） mmol/L]、2 hPG[（10.36±3.22）vs（13.82±2.77）mmol/L]、HbA₁c[（4.28±1.36）% vs （9.22±1.25）%]、HOMA-IR[（2.12±0.85） vs （4.32±1.28） mIU/L]、HOMA-β[（3.89±0.82） vs（4.58±0.79） mmol/L]均低于对照组（P＜0.05）。观察组术后6个月FIns[（14.28±1.33）vs（10.78±2.36） mIU/L]、FC-P[（3.98±1.02）vs（1.39±0.45） µg/L]、2 hIns[（38.12±3.98） vs （33.28±4.15） mIU/L]、2 hC-P[（9.86±2.12） vs（5.18±1.52）µg/L]较术前升高（P＜0.05）。观察组近期并发症发生率和远期并发症发生率均低于对照组[3.22% vs 17.20%；4.84% vs 18.96%, P＜0.05]。  结论  Roux-en-Y吻合术能有效改善胃癌合并T2DM患者胰岛β细胞功能，降低血糖水平，术后并发症发生率低，安全有效。

【关键词】  胃癌；糖尿病；血糖；胰岛功能

The influence of Roux-en-Y anastomosis on islet function in gastric cancer patients combined with diabetes

【Abstract】  Objective  To investigate the effects of Roux-en-Y anastomosis on blood sugar, islet func-tion and complications in patients with gastric cancer and T2DM.  Methods  120 hospitalized patients with gastric cancer (I-II) and T2DM were recruited and divided into observation group (n=62) and control group (n=58). Patients in control group underwent gastro-esophageal anastomosis, and patients in observation group underwent Roux-en-Y anastomosis reconstruction. The changes of blood sugar and insulin before and 6 months after surgery between two groups were compared.  Results  Compared with control group at 6 months after surgery, patients in observation group had lower BMI [（23.36±2.44）vs（25.33±2.92）kg/m²], FPG[（5.58±2.02）vs（8.96±1.75）mmol/L], 2 hPG[（10.36±3.22）vs（13.82±2.77）mmol/L], HbA₁c[（4.28±1.36）% vs（9.22±1.25）%], HOMA-IR[（2.12±0.85）vs（4.32±1.28）] and HOMA-β[（3.89±0.82） vs （4.58±0.79）]（all  P＜0.05）. In observation group, the levels of FIns[（14.28±1.33）vs（10.78±2.36） mIU/L], FC-P[（3.98±1.02）vs （1.39±0.45）µg/L], 2 hIns[（38.12±3.98）vs（33.28±4.15）mIU/L] and 2 hC-P[（9.86±2.12）vs（5.18±1.52）µg/L] were higher after surgery 6 months than before treatment（all P＜0.05）. Both recent and long-term com-plication incidence were lower in observation group than that in control group [3.22% vs 17.20%; 4.84% vs 18.96%, P＜0.05].  Conclusion  Roux-en-Y gastric anastomosis can improve islet function in gastric cancer patients with T2DM and reduce the incidence of postoperative complications.

【Key words】 Gastric cancer；Diaberes mellitus；Blood sugar；Islet function.