Di-san junyi daxue xuebao (Jun 2019)
Effect of delta-shaped anastomosis in digestive tract reconstruction on glucose metabolism in type 2 diabetic patients following total laparoscopic distal gastrectomy for gastric cancer
Abstract
Objective To investigate the effect of delta-shaped anastomosis in digestive tract reconstruction on postoperative glucose metabolism in patients with type 2 diabetes mellitus (T2DM) following total laparoscopic distal gastrectomy (TLDG) for gastric cancer. Methods Ninety patients with T2DM undergoing TLDG for gastric cancer were divided based on the patients' preference and surgical indications into delta-shaped anastomosis group (n=36) and Billroth-Ⅰ digestive tract reconstruction group (control group, n=54). The surgical and perioperative data including body mass index (BMI), insulin dosage, fasting plasma glucose (FPG), postprandial 2 h plasma glucose (2hPG), glycosylated hemoglobin (HbAlc), serum levels of tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), omentin-1, adiponectin, gastric inhibitory peptide (GIP) and glucagon-like peptide-1 (GLP-1), and GIP/GLP-1 ratio were compared between the 2 groups before and at 1, 3, and 6 months after the surgery. Results The incision length, operation time, intraoperative blood loss, the time of first bowel movement and hospital stay were significantly shorter or less in delta-shaped anastomosis group than in the control group (P < 0.05). At 1, 3 and 6 months after the surgery, BMI, FPG, 2hPG, HbAlc, serum levels of TNF-α, IL-6 and GIP and GIP/GLP-1 ratio were significantly lower (P < 0.05) and the serum levels of omentin-1 and adiponectin were significantly higher in delta-shaped anastomosis group than in the control group (P < 0.05). Conclusion In type 2 diabetic patients with gastric cancer, TLDG combined with delta-shaped anastomosis in digestive tract reconstruction is safe and feasible and better improves postoperative glucose metabolism of the patients than classic Billroth-Ⅰ anastomosis.
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