胰岛素强化治疗对胃癌合并糖尿病患者术后的短期观察

Short-term follow-up of intensive insulin therapy on gastric cancer patients with diabetes

目的:评估胰岛素强化治疗对胃癌合并糖尿病患者术后并发症的短期影响。方法:回顾性分析本科室2015年1月至2017年12月40名接受根治性手术的胃癌患者,并纳入本次研究,该40例患者在术前被诊断为2型糖尿病。随机分为胰岛素强化治疗组(n=20,血糖控制在4.4~6.1mmol/L)以及常规血糖控制组(n=20,血糖控制于6.2~11.1mmol/L)。比较两组间术后短期并发症发生情况。结果:两组患者均顺利完成手术,无低血糖事件发生,围手术期间无死亡病例发生。两组间在腹腔感染、胸腔积液、肺部感染、切口愈合不良、吻合口瘘及胃瘫均无统计学差异,两组在术后排气时间上强化组短于常规治疗组(P <0.05),具有统计学差异。结论:胰岛素强化治疗对胃癌合并糖尿病患者术后管理的应用上与常规血糖控制能缩短排气时间,然而在短期并发症上无特别优势,建议该类患者术后常规血糖控制。

Objective： To evaluate the shorbterm effects of intensive insulin therapy on postoperative complications in gastric cancer patients with diabetes. Methods： Retrospective analysis of our department from January 2015 to December 2017, a total of 50 patients undergoing radical surgery for gastric cancer participated in the study. They were diagnosed with type 2 diabetes before surgery. RandomLy divided into insulin intensive treatment group （n 20, blood glucose control in 5. 5-6. 1mmol/L） and conventional blood glucose control group （n 20, blood glucose control in 6.2-11. 1mmol/L）. Shorl term complications after surgery were compared between the two groups. Results： Both groups of patients completed the surgery without any hy poglycemic events, no deaths occurred during the perioperative period. There was no statistical difference between the two groups in abdominal infection, pleural effusion, pulmonary infection, poor incision healing, anastomotic leakage, and gastric fistula. The two groups in the postoperative venting time were shorter in the intensification group than in the conventional treatment group （P〈0. 05）, with statistical differences. Conclusion： The application of insulin intensive treatment on postop erative management of gastric cancer patients with diabetes and conventional blood glucose control can shorten the venting time. However, there is no special advantage in short term complications. Postoperative postoperative conventional blood glucose control is recommended.