46. Retrospective study of the influence of alimentary tract reconstruction after gastrectomy on the blood glucose level in gastric cancer patients complicated with type 2 diabetes mellitus

Objective: To explore the influence of alimentary tract reconstruction after gastrectomy on the blood glucose level in gastric cancer patients complicated with type 2 diabetes mellitus.
Methods: From January 2004 to December 2009, the level of blood glucose and body weight before operation, one month, three months, six months after operation in 87 gastric cancer patients complicated with type 2 diabetes mellitus were retrospectively analyzed. These patients underwent different alimentary tract reconstruction, including 48 patients for Billroth I after distal subtotal gastrectomy (A group), 39 for esophageal Roux-en-Y jejunostomy after total gastrectomy (B group). Glucose level and body weight of these 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 esophageal Roux-en-Y jejunostomy after total gastrectomy were significant changed 1 month, 3 months, 6 months after the operation (P<0.05). Between group A and B the lower value average difference of blood glucose between 1 month, 3 months, 6 months and preoperation was significant (P<0.05). In group B, 6 months after operation 24 patients (61.5%) were free of oral hypoglycemic drugs or insulin dependance, 10 patients (25.6%) needed less oral hypoglycemic drugs or insulin dosage to control hyperglycemia and the total effective rate was 87.1%. In group A, all patients maintained preoperative oral hypoglycemic drugs or insulin dosage. Changes of body weight before and after operation both A and B were significant (P<0.05). But the groups the change of body weight between 1 month, 3 months, 6 months and preoperation was not significant (P>0.05).
Conclusions: Esophageal Roux-en-Y jejunostomy after total gastrectomy has obvious influence on blood glucose level in gastric cancer patients complicated with type 2 diabetes mellitus. It takes about one month for reveal the effect of operation and has nothing to do with weight loss.