老年食管癌贲门癌合并糖尿病的外科治疗  

Surgical treatment for esophageal/gastric cardiac carcinoma with diabetes mellitus in elderly patients

作　　者：余祖滨[1] 姚珂[1] 闵家新[1] 张国强[1] 向明章[1] 

机构地区：[1]第三军医大学附属新桥医院胸外科,重庆400037

出　　处：《老年医学与保健》2009年第2期98-99,共2页Geriatrics & Health Care

摘　　要：目的探讨老年食管、贲门癌合并糖尿病患者的手术治疗。方法回顾性总结72例食管贲门癌合并糖尿病患者的手术治疗经验。结果72例中食管癌61例，贲门癌11例；术前伴慢性阻塞性肺部疾病者10例，伴心血管疾病者13例，伴慢性肾功能不全2例。空腹血糖6．2—14．6mmol／L；手术切除率100％；术后切口感染4例，肺部感染5例，低血糖休克1例，吻合口瘘2例；全组无手术死亡，均顺利渡过手术期。术前、术中、术后均用胰岛素控制糖尿病，补糖以5％等渗液体为主，按1U普通胰岛素4～5g糖的比例补液，血糖保持在略高于正常水平。结论食管贲门癌合并糖尿病是一较严重的临床疾病，术后并发症发生率高，应予以重视，胰岛素的合理应用是治疗成功的关键。Objective To discuss surgical treatment of esophageal/gastric cardiac carcinoma （EC/GCC） complicating diabetes mellitus （DM） in elderly patients. Methods Clinical experience with the treatment of 72 cases of EC/GCC with DM was retrospectively analysed. Results Preoperative diseases in these 72 EC/GCC patients complicated with DM included chronic obstructive pulmonary diseases in 10 patients, cardiovascular diseases in 13 patients, and chronic renal insufficiency in two patients. Fasting blood glucose ranged from 6.2 to 14.6 mmol/L. All carcinomas were resected. Post-operative complications were incisional infection in 4 cases, pulmonary infection in 5 cases, hypoglycemic shock in one patient, and stoma fistula in 5 cases. All patients recovered uneventfully after treatment. General insulin was the key treatment for these patients. Our experience also included administered one unit insulin to 4-5 g glucose infused intravenously and maintenance of blood glucose a bit higher than normal. Conclusions EC/GCC with DM is a serious clinical situation due to high postoperative complications. Appropriate peri-operative insulin treatment is the key to success of treatment.

关 键 词：食管肿瘤 贲门 糖尿病 手术后并发症 胰岛素 

分 类 号：R735.1[医药卫生—肿瘤]