胃大部切除术对非肥胖2型糖尿病的治疗作用.docVIP

胃大部切除术对非肥胖2型糖尿病的治疗作用 　　作者：陈伟杰,胡三元　张光永　　作者单位：山东大学齐鲁医院,山东 济南,250012 　　【摘要】 目的：为明确胃大部切除术对非肥胖2型糖尿病及糖尿病前期患者的治疗作用，并探讨其作用机制。方法：回顾分析2001年1月至2007年5月收入山东大学齐鲁医院普外科接受过胃大部切除术的糖尿病及糖尿病前期患者的临床资料，分析患者的体重指数，比较术前、术后5d以及术后3个月血糖的变化情况及维持正常范围血糖所应用降糖药物的剂量变化。结果：接受胃大部切除术的糖尿病及糖尿病前期患者61例，体重指数(BMI)≤(24.25±3.06)kg/m2。围手术期未应用治疗性胰岛素和其他口服降糖药物的患者，其术后5d及术后3个月血糖水平较术前明显降低;应用治疗性胰岛素和其他口服降糖药物的患者，术后用药剂量减少。结论：胃大部切除术对改善非肥胖2型糖尿病患者的糖代谢有明显的效果。并且采用胃旁路吻合的患者比采用非胃旁路吻合患者糖代谢改善率显著提高。 　　【关键词】 胃大部切除术,糖尿病,2型;血糖 　　【Abstract】 Objective:To investigate whether subtotal gastrectomy can represent an effective therapy for type 2 diabetes and prediabetes in nonobese patients,and try to explain the mechanisms.Methods:The documents of the patients who had been admitted into the department of general surgery of Qilu hospital,and undergone subtotal gastrectomy in the period of Jan.2001 to May 2007 were reviewed.If the patient was concurrent with type 2 diabetes or prediabetes and BMI≤30,the blood glucose levels in the 5th postoperative day and 3rd month were respectively compared with their own preoperative parameters,and the dosage of hypoglycemic medication and the way of anastomosis were analyzed.Results:Sixtyone cases were analyzed.The mean Body Mass Index (BMI) is (24.25±3.06)kg/m2 (SD).In the type 2 diabetes patients without application of diabetic medication or remedial insulin,the mean plasma glucose level in the 5th postoperative day and 3rd month are respectively lower than that before operation.The dosage of hypoglycemic medication used to control blood glucose was reduced for most patients performed subtotal gastrectomy.Moreover,the effects of different anastomosises on improving glucose metabolism are different.Conclusions:Subtotal gastrectomy has a significant effect on type 2 diabetes in nonobese patients.In addition,the effect of gastric bypass is better than other operations on improving glucose metabolism. 　　【Key words】 Subtotal gastrectomy;Diabetes mellitus,type 2;Blood glucose 　　糖尿病是危害人类健康的重