合并糖尿病的老年胃癌患者手术治疗分析

The Analysis of Surgery for Elderly Gastric Cancer Accompanied Diabetes Mellitus

目的探讨分析合并糖尿病的老年胃癌患者的临床特点、手术方式、手术治疗的注意事项及术后处理措施等。方法回顾性分析2006年3月-2011年12月在亳州市人民医院住院接受手术治疗的年龄大于70岁的56例合并糖尿病的老年胃癌患者的临床资料。结果本组行近端胃切除20例,远端胃切除25例,全胃切除11例。消化道重建方式包括:胃-食管吻合术17例、毕Ⅰ式8例、毕Ⅱ式17例、Roux-en-Y吻合14例。术后发生并发症患者12例(21.43%),其中肺部感染4例,ARDS 1例,腹腔感染1例,切口感染2,切口裂开2例,吻合口漏1例、胃肠功能紊乱3例,无低血糖及糖尿病酮症酸中毒。未经控制的糖尿病患者术后并发症的发生率明显高于血糖满意控制的糖尿病患者,差异有统计学意义(P<0.05)。结论合并糖尿病的老年患者临床上应根据老年胃癌患者的临床特点,围术期严格控制血糖,严格掌握手术适应证和禁忌症,加强围手术期的处理,合理选择术式,提高手术的安全性。

Objective To explore the clinical characteristics,the operative method,the points for attention for operation and post-operation treatment of elderly gastric cancer complicated with diabetes mellitus.Methods A retrospective analysis was made to the clinical data of 56 cases of elderly gastric cancer with diabetes mellitus,treated by surgery in our hospital from Mar.2006 to Dec.2011.Results 20 cases of proximal gastrectomy,25 cases of diatal gastrectomy and 11 cases of total gastrectomy had been performed for surgery.The total postoperative complications were 12 cases,including 4 cases pulmonary infection,1 case of ARDS,1 case of abdominal infection,2 cases of incision infection,2 cases of wound disruption,1 case of anastomotic leakage,3 cases of gastrointestinal dysfunction and no hypoglycemia and diabetic ketoacidosis.The incidence of postoperative complications was 21.43%（12/56）.The incidence of postoperative complication in uncontrolled diabetes groups were significantly higher than that of the regular treatment group（P0.05）.Conclusion Gastric cancer in elderly patients with diabetes mellitus should be based on the clinical characteristics of elderly,strict control of perioperative blood glucose,select the appropriate surgical approach,strictly surgical indications,adequate preoperative preparation,perioperative treatment,improve operation security,reduce complications.