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首页 > 期刊列表 > 糖尿病合并急性胆囊炎手术时机的选择
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标题: 糖尿病合并急性胆囊炎手术时机的选择
摘要:

目的:为减少手术风险及术后并发症,进一步探索糖尿病合并急性胆囊炎患者最佳手术时机的选择。方法:回顾性分析2010年6月至2019年5月间新疆乌鲁木齐市三个中心接受急性胆囊炎手术的1 320例糖尿病合并急性胆囊炎患者资料,根据患者入院后0~3d、>3~7d及>7d 的分组数据,分析术后胆道并发症发生率、术中转开腹手术的发生率、住院时间等,多因素Logistic回归分析手术时机与预后的关联性。结果: 0~3 d组858例,>3~7d组330例,>7d组132例,术后需要经内镜逆行性胰胆管造影(ERCP)者所占比例分别为0.9%、1.5%、3.0%,术中胆管损伤需要术后胆总管重建者所占比例分别为0.2%、0.6%、1.5%。>7d组中位年龄65岁,男性及察尔森合并症指数评分(CCI)≥2者占比最高(56.1%、23.5%)(P<0.001)。CCI ≥2分、术前准备时间超过3 d、伴有全身炎症反应综合征(SIRS)发生是术后行ERCP的危险因素(P<0.01),而年龄≥70岁、女性患者、CCI≥2分、术前准备超过3d、伴有SIRS发生是术中胆管损伤需要胆总管重建的危险因素(P<0.01)。结论:对于糖尿病合并急性胆囊炎患者,在确切分析患者病情的基础上早期采取合适的手术治疗能使患者获益更大,而纳入术前CCI及SIRS评分有利于全面术前风险评估。

英文摘要: Objective:To reduce the risk of operation and postoperative complications, further explore the optimal operation time for diabetic patients with acute cholecystitis. Methods:In combination with three centers in Urumqi, a retrospective analysis was made of 1 320 patients with diabetes mellitus who underwent surgery for acute cholecystitis from June 2010 to May 2019. According to the groups data of 0-3 d, >3-7 d and >7 d after admission, the incidence of postoperative biliary complications, incidence of conversion from surgery to open surgery and length of stay were analyzed. Multivariate Logistic regression analysis was used to analyze the correlation between operation timing and prognosis. Results:There were 858 cases in 0-3 d group, 330 cases in >3-7 d group and 132 cases in >7 d group. The proportion of patients who needed ERCP after operation were 0.9%, 1.5% and 3.0% respectively, the proportion of patients who needed common bile duct (CBD) reconstruction during operation were 0.2%, 0.6% and 1.5% respectively. The median age was 65 years old in >7 d group, and the proportion of male and CCI≥2 was the highest (56.1%, 23.5%) (P<0.001). The risk factors of ERCP were CCI≥2, preoperative preparation time more than 3 days, and SIRS (P<0.01). Age≥70 years old, female patients, CCI ≥2, preoperative preparation time more than 3 days, and SIRS were the risk factors of bile duct injury requiring common bile duct reconstruction (P<0.01). Conclusion:For diabetes mellitus patients with acute cholecystitis, early appropriate surgical treatment on the basis of accurate analysis of patients’ condition can make patients benefit, while the preoperative CCI and SIRS score included in the assessment of surgery is conducive to risk assessment.
作者:

邹宏雷1;杨淑芬2

作者单位: 乌鲁木齐,新疆武警兵团总队医院外一科1;乌鲁木齐,新疆维吾尔自治区人民医院肾病科2
期刊: 中华普通外科学文献(电子版)
年.卷(期):页码 2020 .14(4):276-279
中图分类号:
文章编号:
引用格式: [1]邹宏雷1;杨淑芬2.糖尿病合并急性胆囊炎手术时机的选择[J/CD].中华普通外科学文献(电子版),2020,14(4):276-279 .
关键词: 胆囊炎, 急性;糖尿病;胆囊切除术;手术时机
英文关键词: Cholecystitis, acute;Diabetes mellitus;Cholecystectomy;Optimum timing

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