糖尿病对原发性肝癌手术治疗的影响

Effect of Diabetes Mellitus on Surgical Treatment of Primary Hepatocelluar Carcinoma

[目的]分析糖尿病（DM）对原发性肝细胞癌（HCC）手术治疗的影响.[方法]对2003年1月至2009年10月本院收治的186例HCC手术治疗进行回顾性分析,DM合并HCC组52例（DM组）,HCC组134例（非DM组）.[结果]①DM组患者的年龄、入院时空腹血糖、术前准备时间、术后拆线时间、平均住院时间均高于非DM组（P〈0.05）.但两组间肿瘤大小及肝功能水平无统计学差异.②与非DM组相比,DM组患者术后并发症发生率（18/52,34.6%vs14/134,10.4%）明显增高（P〈0.05）,更易出现胸腔积液、胆瘘、膈下感染、切口感染、术后死亡（P〈0.05）.③.DM组中,与无并发症出现的患者相比,有并发症者术前血糖（7.7±1.2 vs 6.8±0.7）及术后7 d的血糖水平（7.8±1.6 vs 6.9±0.9）均较高,年龄大（52±9.1 vs 47±7.9）,肝硬化发生率（12/18,66.7%vs17/34,50.0%）高（P〈0.05）.[结论]HCC合并糖尿病患者手术前后血糖控制极为重要,根据患者的具体情况充分个体化地及时合理调整胰岛素用量是防止术后并发症产生的关键.

[Objective] To analyze the influence of diabetes mellitus（DM） on surgical treatment of primary hepatocelluar carcinoma（HCC）. [Methods] Totally 186 patients with primary HCC undergoing operation in our hospital from Jan. 2003 to Oct. 2009 were analyzed retrospectively. Among all patients, 52 patients were HCC with DM（DM group） and 134 patients were HCC without DM（non-DM group）. [Results] The age, fast ing plasma glucose（FPG） on admission, the set up time before operation, the time of taking out stitches after operation and the average stay in DM group were all higher than those in non-DM group, but there was no statistical difference in tumor size and liver function between the two groups. Compared with non-DM group, the incidence of postoperative complications in DM group increased significantly（34.6% vs 10.4%）（ P 〈0.05）, and pleural effusion, biliary fistula, midriff infection, incision infection and death more easily appeared in DM group（ P 〈0.05）. In DM group, compared with patients without complications, plasma glucose before operation and 7 days after operation in patients with complications was higher（7.7±1.2 vs 6.8±0.7 and 7.8±1.6 vs 6.9±0.9）, and their ages were older（52±9.1 vs 47±7.9）, and the incidence of liver cirrhosis was higher （12/18,66.7% vs 17/34,50.0%）（ P 〈0.05）. [Conclusion] It is very important to control the plasma glucose of the patients of HCC with DM before and after operation. To modulate the dose of insulin fully and promptly according to their exact condition is the key to the prevention of the complications after operation.