合并2型糖尿病的胆囊结石病患者微创保胆取石术效果观察  

Effect observation of micro-invasive cholecystolithotomy for patients with gallstone disease complicated with type 2 diabetes

作　　者：鲁蓓 石玉宝 刘斌 郑卫 

机构地区：[1]北方学院附属第二医院,河北省宣化市075100

出　　处：《临床合理用药杂志》2017年第5期10-12,共3页Chinese Journal of Clinical Rational Drug Use

基　　金：河北省科技支撑计划项目(No:-12110049D)

摘　　要：目的观察2型糖尿病患者实施腹腔镜胆道镜联合微创保胆取石术的可行性。方法选取术前胆囊收缩功能≥30%胆囊结石患者114例,实施腹腔镜胆道镜双镜联合微创保胆取石术。其中合并2型糖尿病(DM组)56例,非糖尿病患者(n DM组)58例。术后3个月内均恢复顺利,无手术切口感染、肺部感染、胆瘘、胆道损伤及胆道狭窄等并发症发生。比较2组胆囊最大收缩率变化情况、术后胆囊结石复发率。结果 DM组术后3个月时胆囊最大收缩率为(33.5±5.1)%,低于术前的(40.7±8.3)%,差异有统计学意义(P<0.05);但在术后12个月及24个月时最大收缩率分别达到(43.4±6.3)%和(50.7±12.9)%,明显优于术前(P<0.05);且DM组最大收缩率与同期n DM组比较(P>0.05)。术后2年2组结石复发率比较差异无统计学意义(P>0.05)。结论 2型糖尿病病程短、平诉血糖控制良好的胆囊结石患者,术前胆囊收缩功能良好,微创保胆取石术后,胆囊收缩功能依然良好,术后2年结石复发率与非糖尿病患者相当。术后较远期的胆囊收缩功能变化及结石复发率有待进一步研究。Objective To investigate the feasibility of Micro-invasive cholecystolithotomy for patients with type 2 dia- betes mellitus and gallstone. Methods The gallbladder function of 114 gallstone patients before surgery were not less than 30% , all patients were implemented by the minimally invasive laparoscopic and cholangioscopic for preservation of gallblad- der,56cases of those patients were with type 2 diabetes（DM group）,others 58cases were not with type 2 diabetes（nDM group）. All patients recovered smoothly within 3 months after operation. There were no complications such as incision infec- tion, pulmonary infection, biliary fistula, bile duct injury and biliary stricture. The change of the maximum shrinkage rate and the recurrence rate of cholecystolithiasis in 2 groups were compared. Results The maximum shrinkage of gallbladder in DM group was （ 33.5 ＋ 5.1 ） % at 3 months after surgery, lower than （40.7 ＋ 8.3 ） % before surgery, the difference was statistically significant （P 〈 0. 05 ）. However, the maximum shrinkage at 12 and 24 months after surgery was （43.4 ＋ 6.3 ） % and （ 50.7 ~ 12.9） % , respectively, much better than the preoperative, the difference was statistically significant （ P 〈 0.05 ）. Com- pared with the nDM group in the same time, there was no significant difference in the maximum shrinkage （ P 〉 0.05 ）. The rate of postoperative recurrence of stones in later two years between the two groups was no statistically significant （ P 〉 0.05 ）. Conclusion Type 2 diabetic patients are with short course of disease. For patients with gallbladder calculus with good glyce- mic control, the preoperative gallbladder contraction function of which is good. The gallbladder function was still good after mi- cro-invasive cholecystolithotomy. The recurrence rate of stones in 2 years after surgery was comparable to that of non diabetics. The change of gallbladder contraction function and the recurrence rate of gallstone after the operation need to be further stud-

关 键 词：2型糖尿病 微创保胆取石术 胆囊收缩功能 结石复发 

分 类 号：R657.42[医药卫生—外科学] R587.1[医药卫生—临床医学]