糖尿病对胰腺癌患者胰十二指肠切除术后早期并发症的影响  

Impact of diabetes on early complications after pancreaticoduodenectomy in patients with pancreatic cancer

作　　者：端传友[1] 王新波[2] 

机构地区：[1]南京大学医学院,210093 [2]南京军区南京总医院解放军普通外科研究所

出　　处：《中国综合临床》2016年第2期160-164,共5页Clinical Medicine of China

摘　　要：目的探讨糖尿病对胰腺癌患者胰十二指肠切除术后早期并发症的影响，为临床诊治提供参考。方法选择179例行胰十二指肠切除术并经病理证实的胰腺癌患者，根据血糖水平分为糖尿病组8l例和非糖尿病组98例，糖尿病组术前FPG控制在5．6～11．2mmol／L，比较两组临床病理资料、手术相关并发症和全身并发症。结果179例患者中，5例（2．79％）死亡，均死于严重感染合并心肺功能衰竭。糖尿病组胰腺质地硬者较非糖尿病组多（79．0％比42．9％，χ^2=13．62，P〈0．01），两组手术时间、术中出血量、住院时间、胰管直径、肿瘤大小、病理类型、是否保留幽门及吻合方式差异均无统计学意义（P均〉0．05）；两组术后胰瘘、胃排空延迟、出血、感染的发生率差异均无统计学意义（P均〉0．05），糖尿病组呼吸衰竭[4．9％（4／81）]、心力衰竭[9．9％（8／81）]、肾衰竭[1．2％（1／81）]发生率均显著高于非糖尿病组[2．0％（2／98）、3．1％（3／98）、0（0／98）]（P值分别为0．031、0．014、0．007）。本组胰瘘发生率为26．3％（47／179），其中38．3％（18／47）合并糖尿病，40．4％（19／47）胰腺质地硬，合并糖尿病及胰腺质地硬者胰瘘的发生率较非糖尿病者、胰腺质地软者更低（χ^2=8．53，P〈0．05；χ^2=11．20，P〈0．01）。结论胰腺癌患者行胰十二指肠切除术风险较大，合并糖尿病患者术前积极控制血糖水平不会明显增加术后发生胰瘘、胃排空延迟、出血、感染的风险，但糖尿病史对全身并发症有较大影响，术前及术后应该积极控制血糖水平。Objective To investigate the influence of diabetes on the early complications after pancreaticoduodenectomy in patients with pancreatic cancer, and to provide reference for clinical diagnosis and treatment. Methods A total of 179 patients with pancreatic cancer confirmed by pathology underwent pancreaticoduodenectomy were divided into 81 cases of diabetes group and 98 cases of non-diabetes group according to the level of blood sugar. The fast blood glucose of patients in diabetes group were controlled at 5.6- 11.2 mmol/L before surgery, the clinical and pathological data, surgery-related complications and systemic complications of two groups were compared. Results Of 179 patients, 5 patients （ 2. 79% ） died of severe infection combined with cardiac and respiratory failure. Firm pancreatic texture occurred more in diabetes group than that in non-diabetes group （ 79.0% vs 42. 9%, χ^2= 13.62, P〈 0. 01 ） , but no statistically significant difference in duration of operation, total bleeding, length of stay in hospital, diameter of pancreatic duct, tumor size, pathological pattern, whether reserved pylorus and methods of anastomosis between the two groups （P 〉0. 05）. There was no statistically significant difference in the incidence of pancreatic fistula, delayed gastric emptying, hemorrhage and infection between diabetes group and non-diabetes group （P 〉 0. 05 ）, but the incidence of respiratory failure （ 4. 9% （ 4/81 ） ）, cardiac failure （ 9. 9% （ 8/81 ） ） and renal failure （ 1.2% （ 1/81 ） ） in diabetes group were significantly higher than that in non-diabetes group （ 2. 0% （ 2/98 ）, 3.1% （ 3/98 ）, 0（0/98） ; P = 0. 031, 0. 014, 0. 007 ）. The incidence of pancreatic fistula was 26. 3% （ 47/179 ）, and that of patients combined with diabetes （ 38. 3% （ 18/47 ） ） and finn pancreatic texture （ 40.4% （ 19/47 ） ） were statistically lower than patients without diabetes and soft pancreatic texture （ χ^2= 8.53, P 〈 0. 05 ; χ^2 = 11.20, P�

关 键 词：胰腺肿瘤 糖尿病 胰十二指肠切除术 并发症 病理 

分 类 号：R657.5[医药卫生—外科学]