不同手术时机的选择对糖尿病合并急性胆囊炎患者的影响

The Influence of Different Operation Timing on Patients with Diabetes Complicated with Acute Cholecystitis

目的观察不同手术时机对患者的治疗效果,为糖尿病合并急性胆囊炎患者的诊治提高依据。方法选取2015年1月—2019年12月在外科确诊的糖尿病合并急性胆囊炎患者180例为研究对象。均为2型糖尿病。根据手术时机不同分为3组:分为A组(0~72 h)59例,B组(72 h~7 d)61例,C组(>7 d)60例。分别记录患者性别、年龄、血糖、临床表现等并记录出院情况。进行3组患者手术过程的比较,包括手术时间、手术出血量、血糖控制情况,及3组患者并发症的比较。结果3组患者手术时间、手术出血量、平均血糖波动指标对比,A组手术时间(1.10±0.15)h、手术出血量(80.92±13.62)mL及平均血糖波动(3.57±0.53)mmol/L均低于B组、C组,差异有统计学意义(t=10.981、315.37、3.391,P<0.05),B组与C组间手术时间、手术出血量及平均血糖波动差异无统计学意义(P>0.05),3组间低血糖发生率、高渗性昏迷发生率差异无统计学意义(P>0.05)。3组患者治疗后并发症发生率对比,包括穿孔、腹腔内出血、胆管损伤、转为开腹手术,A组(1/61、3/61、1/61、4/61)明显低于B组、C组,差异有统计学意义(χ^(2)=6.119、8.307、6.574、7.397,P=0.047、0.016、0.037、0.025),B组与C组间差异无统计学意义(P>0.05)。3组患者治疗后并发症感染、坏疽差异无统计学意义(P>0.05)。结论糖尿病合并急性胆囊炎患者早期手术获益较大。

Objective To observe the effect of different operative timing on patients,and to improve the diagnosis and treatment of diabetic patients with acute cholecystitis.Methods A total of 180 patients with diabetes and acute cholecystitis diagnosed surgically from January 2015 to December 2019 were selected as the research objects.All are type 2 diabetes.According to the timing of surgery,they were divided into three groups:group A(0-72 h)with 59 cases,group B(2 h-7 d)with 61 cases,and group C(over 7 d)with 60 cases.Record the patient's gender,age,blood glucose,clinical manifestations,etc.and record the discharge status.The comparison of the operation process of the three groups of patients includes the comparison of operation time,surgical blood loss,blood glucose control,etc.and the comparison of the complications of the three groups of patients.Results There was comparison among the three groups of patients in operation time,operation blood loss,and average blood glucose fluctuation.Operation time(1.10±0.15)h,surgical blood loss(80.92±13.62)mL and average blood glucose fluctuation(3.57±0.53)mmol/L in group A were lower than those in group B and group C,the difference was statistically significant(t=10.981,315.37,3.391,P<0.05).There was no statistically significant difference in operation time,operation blood loss and average blood glucose fluctuation between group B and group C(P>0.05).There was no statistically significant difference in the incidence of hypoglycemia and hyperosmolar coma among the three groups(P>0.05).After treatment,the three groups had differences in complications rates,induding perforation,intra-abdominal hemorrhage,bile duct injury,and conversion to open surgery,and group A(1/61,3/61,1/61,4/61)was significantly lower than group B and group C,the difference was statistically significant(χ^(2)=6.119,8.307,6.574,7.397,P=0.047,0.016,0.037,0.025).There was no statistically significant difference between group B and group C(P>0.05).There was no statistically significant difference in complication infection and gangrene after treatment in the three groups(P>0.05).Conclusion Patients with diabetes and acute cholecystitis benefit from early surgery.