摘要
目的探讨血糖控制良好2型糖尿病合并胆囊结石患者行腹腔镜联合胆道镜微创保胆取石术治疗前后胆囊收缩功能的变化及胆囊结石复发率。方法选取2009年6月—2012年6月河北北方学院附属第二医院收治的血糖控制良好2型糖尿病合并胆囊结石患者60例为试验组,同期选择未合并糖尿病的胆囊结石患者60例为对照组,试验组患者入院后均使用普通胰岛素控制血糖,围术期控制空腹血糖≤7.2 mmol/L,餐后2h血糖≤9.0 mmol/L。两组患者均行腹腔镜联合胆道镜微创保胆取石术,分别于术前及术后3、12、24个月行Lundh试餐超声检查检测胆囊最大收缩率,术后3、12、24个月采用胆囊B型超声检查胆囊结石复发情况。结果所有患者术后恢复顺利,围术期无手术切口感染、胆管感染、胆漏、胆管损伤及死亡;随访无急性胆囊炎、胆管炎及肝内外胆管结石、胆管狭窄发生;2例复发胆囊结石患者夜间胆绞痛发作,最长持续2h,未行特殊治疗,改变体位后逐渐缓解。随访24个月期间,6例退出试验,其中对照组2例,试验组4例。两组患者治疗方法与时间在胆囊最大收缩率上不存在交互作用（F_（交互）=0.469,P_（交互）=0.707）,治疗方法在胆囊最大收缩率上主效应不显著（F_（组间）=0.850,P_（组间）=0.365）,时间在胆囊最大收缩率上主效应显著（F_（时间）=8.880,P_（时间）=0.001）。两组患者术前及术后3、12、24个月胆囊最大收缩率比较,差异均无统计学意义（P〉0.05）。对照组和试验组患者术后3个月胆囊最大收缩率较术前降低（P〈0.05）;对照组和试验组患者术后12、24个月胆囊最大收缩率较术后3个月升高（P〈0.05）。两组术后3个月均无胆囊结石复发;术后12个月对照组有1例（1.7%,1/58）胆囊结石复发,试验组有1例（1.8%,1/56）胆囊结石复发,差异无统计学意义（χ^2=0.001,P=0.980）;术后24个月对照组有2例（3.4%,2/58）胆囊结石复发,试验组有2例（3.6%,2/56）胆囊结石复发,差异无统计学意义（χ^2=0.001,P=0.972）。结论血糖控制良好2型糖尿病合并胆囊结石患者行腹腔镜联合胆道镜微创保胆取石术,能较好地保留和改善胆囊收缩功能,术后24个月胆囊收缩功能依然良好;术后24个月内胆囊结石复发率与非糖尿病患者无差异。
Objective To investigate the change of gallbladder contractive function and the recurrence rate of gallstone after the therapy of laparoscope combined with choledochoscopic microinvasive gallbladder- protected lithotomy on T2DM patients combined with gallstone having good blood glucose control.Methods From June 2009 to June 2012,we enrolled 60 T2DM patients combined with gallstone as experimental group and enrolled 60 gallstone patients without DM as control group from the Second Affiliated Hospital of Hebei North Medical University.Patients of experimental group all used normal insulin to control blood glucose.Perioperative fasting blood glucose was controlled ≤7.2 mmol/L,and 2 h postprandial blood glucose was controlled ≤9.0 mmol/L.Patients of both groups underwent laparoscope combined with choledochoscopic microinvasive gallbladder- protected lithotomy.Before surgery and 3,12 and 24 months after surgery,Lundh meal ultrasound examination was conducted to examine the maximum contractive rate of gallbladder,and 3,12 and 24 months after surgery,gallbladder B ultrasound examination was conducted to examine the recurrence of gallstone.Results All patients recovered smoothly without surgical incision infection,infection of biliary tract,bile leak,bile duct injury or death in perioperative period;no acute cholecystitis,cholangitis,intra- and extrahepatic bile duct stone and biliary stricture occurred;biliary colic attacks occurred at night in 2 patients with recurrent gallstone and lasted for 2 hours at most,and the two patients relieved gradually without special treatment after body position change.During the 24- month following- up period,6 cases dropped out of the experiment,of which were 2 cases in control group and 4 cases in experiment group.There was no interactions between the maximum shrinkage rate of gallbladder treatment and time of patients in two groups（F_（interaction）= 0.469,P_（interaction）=0.707）,there was no significant effects between groups（F_（group）=0.850,P_（group）=0.365）,there was significant effects among different time（F_（time）=8.880,P_（time）=0.001）.The two groups were not significantly different in the maximum gallbladder contractive rate before surgery,and 3,12 and 24 months after surgery（P〈0. 05）.Control group and experimental group had lower maximum gallbladder contractive rate3 months after surgery than that before surgery（P〈0. 05）;control group and experimental group had higher maximum gallbladder contractive rate 12 and 24 months after surgery than that 3 months after surgery（P〈0. 05）.No recurrence of gallstone was found in both groups 3 months after surgery;12 months after surgery,there was 1（1.7%,1/58） patient in control group and 1（1.8%,1/56） patient in experimental group who had recurrence,and there was no significant difference between them（χ~2=0.001,P =0.980）;24 months after surgery,there were 2（3.4%,2/58） patients in control group and2（3.6%,2/56） patients in experimental group who had recurrence of gallstone,and there were no significant difference between them（χ~2=0.001,P-0.972）.Conclusion Laparoscope combined with choledochoscopic microinvasive gallbladder- protected lithotomy on T2 DM patients combined with gallstone having good blood glucose control can well protect and improve the gallbladder contractive function and keep good gallbladder contractive function 24 months after surgery.There is no difference between diabetic patients and non- diabetic patients in the recurrence rate of gallstone within 24 months after surgery.
出处
《中国全科医学》
CAS
CSCD
北大核心
2016年第21期2505-2508,共4页
Chinese General Practice
关键词
糖尿病
2型
胆囊结石病
微创保胆取石
治疗结果
复发
Diabetes mellitus
type 2
Cholecystolithiasis
Micro-invasive cholecystolithotomy
Treatment outcome
Recurrence
