食管、贲门癌伴糖尿病患者的围手术期处理

The Perioperative Treatment for Carcinoma of the Esophagus and Gastric Cardia with Diabetes Mellitus

目的：探讨食管贲门癌合并糖尿病的围手术期处理。方法：回顾性总结15例食管贲门癌合并糖尿病的治疗经验。结果：15例中食管癌12例，贲门癌3例；术前伴慢性阻塞性肺部疾病者2例，伴心血管疾病者9例；发现癌肿时糖尿病诊断已成立者6例，另9例为术前检查所发现，空腹血糖5．9－14．6mmol／L；根治性切除11例，姑息性切除4例，切除率100％；术后胸部切口感染5例；发生低血糖体克1例；全组除1例死于糖尿病高渗性昏迷外，其余均顺利／经相应处理后渡过手术期。术前、术中、术后均用普通胰岛素控制糖尿病，补糖以5％的等渗液体为主，按1u普通胰岛素：5g糖的比例补液，并按尿糖一个"＋"：3u胰岛素的剂量追加，使患者尿糖控制在"＋-＋＋"、血糖保持在略高于正常的水平。术后7天开始进食后逐渐改用口服降糖药。结论：食管责门癌合并糖尿病系一较严重且常见的临床情况，术后并发症发生率高，应予以重视，胰岛素的合理应用是治疗成功的关键。

Objective To discuss the perioperative treatment for esophageal/gastric cardiac carci- noma (EC/GCC)complicating diabetes mellitus (DM). Method: We retrospectively analysed the clinicalexperience of treatment for 15 cases of CE/GCC with DM. Results: All of 15 patients complicated DM.Besides, 9 cases also suffered from cardiovascular diseases, 2 cases with chronic obstractive pulmonarydiseaese. DM were diagnosed in 6 cases before cancer, in 9 after cancer, with blood glucose rangingfrom 5. 9 to 14. 6mmol/L. All of carcinomas were resected, 11 radical resections and 4 palliative opera-tions. The postoperative complications were 5 incision infection, 1 hypoglycemic coma. All, except 1death from hyperosmotic nonketonic coma, recovered smoothly after the treatment. General insulin waskey treatment for these patients. One unit insulin to sg glucose infused intravenous with 3u insulin to '+' urine glucose as an additional dosage made urine glucose at' +-++'and blood glucose higher thannormal level a little. After recovering oral intake, the medicaton was changed from insulin to oral pills.Conclusion: EC/GCC with DM is a serious cliniclal situation due to high postoperative complication.Suitable insulin treatment in perioperative period is the key medication.[