食管癌及贲门癌伴糖尿病89例的围术期治疗

Perioperative management of esophageal or cardiac cancer in 89 cases accompanied with diabetes mellitus

目的:探讨食管癌及贲门癌伴糖尿病患者围术期治疗的最佳方式。 方法:回顾性分析了 89例食管癌及贲门癌伴糖尿病患者的外科治疗 ,将治疗的重点放在对糖尿病监测和控制上。术前 3d停用口服降糖药 ,改为早、中、晚餐前胰岛素皮下注射 ,术中监测血糖 ,术后禁食水期间 ,每日补充的葡萄糖量不低于 12 5～ 15 0 g,并按糖∶胰岛素为 4～ 5∶ 1的比例给予胰岛素治疗 ,以防发生酮症酸中毒。 结果 :全组治愈 87例 ,死亡 2例。 结论:对于食管癌及贲门癌伴糖尿病患者 ,将血糖控制在 6～ 9mm ol/L,尿糖控制在 (± )时实施手术较为安全。另外应用有效的抗生素预防术后感染也是保证手术成功的重要因素之一。

Objective: To investigate the optimum measures of treatment on perioperative patients of esophageal or cardiac cancer with diabetes mellitus. Methods: Eighty nine patients of esophageal or cardiac cancer with diabetes underwent surgical treatment were analyzed retrospectively. The focus of treatment was located on the monitoring and control of diabetes. The administration of oral hypoglycemic drugs was ceased three days before operation, and transferred to subcutaneous injection of insulin at morning, noon, night. Monitoring of blood glucose should be made during operation. The glucose infused every day should be no less than 125 to 150 g during the period of postoperative fasting and insulin therapy should be adopted simultaneously in case of ketoacidosis developed in proportion as 4g glucose: 10 insulin. Results: Among these 89 cases , there were 87 patients cured and 2 died. Conclusions: For the patients with esophageal or cardiac cancer accompanied diabetes, the perform of operation is relatively safe when the blood glucose is controlled in the range of 6 to 9 mol/L, the urine glucose below (±). In addition, effective application of antibiotic to prevent postoperative infection is one of the important factors ensuring a successful operation.