食管癌贲门癌合并糖尿病的手术治疗探讨——附31例临床报告

Discussion on the surgical treatment of cancer of esophageal and cardiac with diabetes——Clinical report of 31 cases

目的探讨食管癌贲门癌伴糖尿病患者的手术治疗体会。方法回顾性分析2005-04—2012-03,收治31例食管癌贲门癌合并糖尿病患者的外科治疗围手术期处理及血糖控制经验。结果本组无死亡病例,治愈30例,1例手术中突然发生室颤而放弃手术。术后主要并发症:颈部吻合口瘘2例,肺部感染并急性呼吸衰竭,气管切开使用呼吸机2例。结论食管癌贲门癌伴糖尿病患者,围手术期血糖控制是手术成败的关键;术前将血糖控制在6.0～9.0 mmol/L,尿糖控制在(±)时,实施手术较为安全。食管癌术式以颈部吻合为主,十二指肠营养管管饲,是保证手术成功的重要因素。

Objective To investigate the surgical treatment of esophageal and cardiac associated with diabetes. Methods A retrospective analysis of 2005.4-2012.3, my hospital, 31 patients with esophageal and cardiac surgical treatment of patients with diabetes mellitus periop- erative management and blood glucose control experience. Results There were no deaths, 30 cases were cured, and the sudden occurrence of ventricular fibrillation surgeries do gymnastics to give up surgery. The main postoperative complications： neck anastomotic fistula in two cases, lung infections and acute respiratory failure, tracheotomy ventilator. Conclusion on diabetic patients with esophageal and cardiac, perioperative glucose control is the key to the success of surgery ; preoperative glycemic control in 6.0 -9.0 mmol/L, urine sugar control, the implementa-tion of safer surgery . Esophageal surgical reconstruction of the digestive tract - based cervical anastomosis and duodenum nutrition tube feed-ing, is also an important factor to ensure successful operation.