糖尿病对老年患者行腹腔镜胆囊切除术的影响

Effects of diabetes on laparoscopic cholecystectomy in elderly patients

目的探讨糖尿病对老年患者行腹腔镜胆囊切除术(LC)相关并发症发生情况的影响。方法回顾性分析145例(≥60岁)患者LC的临床资料,比较有无糖尿病两组患者手术并发症的发生情况。结果糖尿病组患者52例,其中胆囊破裂5例,胆漏4例,切口感染4例,腹腔感染3例,肺部感染4例,十二指肠损伤1例,脐疝形成1例,腹腔内出血3例,胆管损伤1例,胆管结石残留3例,并发症发生率为19.2%。无糖尿病组患者93例,期中胆囊破裂1例,肺部感染1例,胆管损伤3例,皮下气肿2例,胆管结石残留3例,并发症发生率为8.6%。糖尿病组患者有6例中转开腹,而无糖尿病组患者仅2例中转开腹,两组患者的中转开腹率分别为11.5%和2.2%,差异具有统计学意义(P<0.05)。糖尿病组患者术中出现胆囊破裂、术后发生胆漏和切口感染的发生率均较无糖尿病组患者高(P<0.05),住院天数较无糖尿病组患者明显延长(P<0.05)。结论糖尿病是LC手术并发症发生的危险因素之一,应引起重视。老年糖尿病患者在围手术期管理中应常规监测血糖浓液,必要时强化胰岛素治疗以降低手术并发症的发生。

Objective To explore the effect of diabetes on post-operative complications in elderly patients with laparoscopic cholecystectomy （LC）. Methods Clinical data of 145 patients underwent LC （ age≥ 60 years） were retrospectively analyzed. The incidences of complications were compared between diabetic and non-diabetic patients. Results There were 52 cases in the diabetic patient group, among which there were 5 ruptured gallbladder cases, 4 bile leakage cases, 4 wound infection cases, 3 abdominal infection cases, 4 pulmonary infection cases, 1 duodenal injury case, 1 umbilical hernia case, 3 intra-abdominal hemorrhage case, 1 bile duct injury case, and 3 residual bile duct stones cases. The post-operative complication rate was 19.2%. There were 93 cases in the non-diabetic patient group, among which there were 1 ruptured gallbladder case, 1 pulmonary infection case, 3 bile duct injury cases, 2 subcutaneous emphysema cases, and 3 residual bile duct stones cases. The post-operative complication rate was 8.6%. Six cases of diabetic patient group were undergone convertion laparotomy, while only two cases of non-diabetic patient group were undergone convertion laparotomy. The rates of convertion laparotomy were 11.5% and 2.2%, respectively. The difference was statistically significant （P 〈 0.05）. The rates of intraoperative rupture of the gallbladder, bile leakage and wound infection of diabetic patient group were significantly higher than those of non-diabetic patient group （P 〈 0.05）. The hospital days of diabetic patient group were also significantly longer than those of non-diabetic patient group （P 〈 0.05）. Conclusion Diabetes is one of the risk factors of operative complications after laparoscopic cholecystectomy and to which attention should be paid. The blood glucose of elderly diabetic patients should be regularly monitored during the peri-operative management. Intensive insulin therapy may performed to reduce the incidence of complications if necessary.