食管癌术中行胸导管结扎对2型糖尿病患者物质代谢及短期并发症的影响

Impact of thoracic duct ligation on substance metabolism and surgical complications in patients with type-2 diabetes mellitus during esophagectomy

目的探讨食管癌术中行胸导管结扎术对2型糖尿病患者营养物质代谢及短期并发症的影响。方法回顾性分析2003年1月至2018年12月于上海长海医院胸外科行手术治疗的230例食管癌合并2型糖尿病患者的临床资料,根据术中是否行胸导管结扎分为结扎组(n=112),其中男78例、女34例,年龄(63.47±7.23)岁,和未结扎组(n=118),其中男84例、女34例,年龄(64.38±7.57)岁。使用倾向性匹配法控制混杂因素,比较两组患者围手术期的血糖、肝功能、脂质代谢参数及术后短期并发症。结果经匹配后两组基线资料无明显差异,每组患者各59例。结扎组除术后第4 d,血糖值均高于未结扎组,差异有统计学意义(P<0.05)。结扎组术后第1 d和第4 d的总蛋白和白蛋白水平明显低于未结扎组(P<0.05),且术后第4 d谷草转氨酶(P=0.027)和谷丙转氨酶(P=0.007)明显高于未结扎组。此外,结扎组肺部并发症(P=0.014)和吻合口瘘发生率(P=0.047)高于未结扎组,差异有统计学意义。结论胸导管结扎可能会加重2型糖尿病患者营养代谢障碍,增加肺部并发症和吻合口瘘的发生率,对于此类患者,胸导管结扎应当谨慎实施,不推荐行常规的预防性胸导管结扎术。

Objective To investigate the impact of thoracic duct ligation(TDL)on metabolism and postoperative complications during esophagectomy in patients with type-2 diabetes mellitus(T2DM).Methods We conducted a retrospective clinical data analysis of 230 esophageal carcinoma patients with T2DM who underwent esophagectomy in our hospital from January 2003 to December 2018.Patients were divided into a TDL+group(n=112),including 78 males and 34 females aged 63.47±7.23 years,and a TD L-group(n=l18),including 84 males and 34 females aged 64.38±7.57 years.We compared the blood glucose,liver function parameters and lipid metabolic parameters at different time points before and after surgery.In addition,we compared the postoperative major complications between the two groups.Propensity score-matched(PSM)was used to control the observed confounders.Results Compared with the TD Lgroup,patients in TDL+group had higher blood glucose level(P<0.05,except the fourth postoperative day).The total protein and albumin levels on the first and fourth postoperative days in the TDL+group were lower than those in the TD L-group(P<0.05).The alanine transaminase(P=0.027)and aspartate transaminase(P=0.007)levels on the fourth postoperative day in the TDL+group were higher than those in the TD L-group.More pulmonary complications(P=0.014)and anastomotic leaks(P=0.047)were found in the TDL+group.Conclusion Given that TDL may aggravate metabolic disorders,increase anastomotic leaks and the pulmonary complications,it is cautious to perform TDL,and prophylactic TDL should not be performed routinely for patients with T2DM.