目的 探讨急诊腹腔镜阑尾切除术对急性化脓性阑尾炎合并2型糖尿病患者胰腺内分泌功能以及患者预后的影响.方法 回顾性分析2012年10月至2014年10月重庆医科大学附属永川医院收治的76例急性化脓性阑尾炎合并2型糖尿病患者的临床资料.患者均行急诊阑尾切除术,其中41例患者行腹腔镜阑尾切除术,设为腹腔镜组;35例患者行开腹阑尾切除术,设为开腹组.观察两组患者术中情况;采取酶联免疫吸附法检测术前15 min(t1)、手术开始后15 min(t2)、手术开始后30 min(t3)、手术结束后30 min(t4)两组患者血清C肽、胰岛素及血糖的水平;分析患者术后恢复情况.术后采用电话随访,随访时间截至2014年12月.符合正态分布的计量资料以(x)±s表示,组间比较采用成组t检验和重复测量方差分析.计数资料的比较采用Fisher确切概率法.结果 两组患者均顺利完成手术,腹腔镜组患者手术时间和术中出血量分别为(50 ±7) min和(8.4 ±3.4)mL;开腹组分别为(52±7) min和(7.7±2.9)mL,两组比较,差异均无统计学意义(t=1.291,1.042,P＞0.05).腹腔镜组患者术中发现阑尾周围组织粘连包裹严重8例,开腹组11例,两组比较,差异无统计学意义(P＞0.05).血清学指标监测结果显示:腹腔镜组患者血清C肽t1～t4分别为:(62.5±3.3) μ,g/L、(70.7±2.9) μg/L、(86.5±3.4) μg/L、(68.1±2.6) μg/L,开腹组分别为(63.8±2.8) μg/L、(95.6 ±5.1) μg/L、(106.6±2.3) μg/L、(67.5±4.9)μg/L;腹腔镜组患者血清胰岛素t1～t4分别为:(13.1±1.0) mU/L、(14.0±1.1) mU/L、(15.1±1.2) mU/L、(13.5±1.1)mU/L,开腹组分别为(13.3±0.4)mU/L、(15.4±0.6)mU/L、(18.2±0.7) mU/L、(13.5±0.4) mU/L;腹腔镜组患者血糖t1～t4分别为:(7.8±1.0) mmol/L、(8.3±1.0) mmol/L、(8.9±1.0) mmol/L、(8.1±1.0) mmol/L,开腹组分别为(7.8±0.4) mmol/L、(8.7±0.5) mmol/L、(10.1±0.4) mmol/L、(7.9±0.5) mmol/L,上述3种血清学指标变化趋势不同,两组比较,差异均有统计学意义(F =378.917,286.602,118.199,P＜0.05).患者术后恢复情况:腹腔镜组患者术后肛门排气时间为(1.2 ±0.4)d,开腹组为(1.3 ±0.5)d,两组比较,差异无统计学意义(t=-0.355,P＞0.05).腹腔镜组患者术后腹痛持续时间为(1.5±0.6)d,开腹组为(2.5 ±0.7)d,两组比较,差异有统计学意义(t=-6.367,P＜0.05).腹腔镜组患者术后伤口感染6例、发热10例,开腹组分别为14例和22例,两组比较,差异均有统计学意义(P＜0.05).腹腔镜组患者住院时间为(5.2 ±0.4)d,开腹组为(6.3±0.8)d,两组比较,差异有统计学意义(t=7.796,P＜0.05).两组患者均获得随访,中位随访时间为8个月(2～18个月),均未发生粘连性肠梗阻,无明显腹痛、腹胀等不适,无阑尾残株炎发生.结论 急诊腹腔镜阑尾切除术与开腹手术比较,对急性化脓性阑尾炎合并2型糖尿病患者胰腺内分泌功能的影响较小,有利于患者术后康复.
目的 探討急診腹腔鏡闌尾切除術對急性化膿性闌尾炎閤併2型糖尿病患者胰腺內分泌功能以及患者預後的影響.方法 迴顧性分析2012年10月至2014年10月重慶醫科大學附屬永川醫院收治的76例急性化膿性闌尾炎閤併2型糖尿病患者的臨床資料.患者均行急診闌尾切除術,其中41例患者行腹腔鏡闌尾切除術,設為腹腔鏡組;35例患者行開腹闌尾切除術,設為開腹組.觀察兩組患者術中情況;採取酶聯免疫吸附法檢測術前15 min(t1)、手術開始後15 min(t2)、手術開始後30 min(t3)、手術結束後30 min(t4)兩組患者血清C肽、胰島素及血糖的水平;分析患者術後恢複情況.術後採用電話隨訪,隨訪時間截至2014年12月.符閤正態分佈的計量資料以(x)±s錶示,組間比較採用成組t檢驗和重複測量方差分析.計數資料的比較採用Fisher確切概率法.結果 兩組患者均順利完成手術,腹腔鏡組患者手術時間和術中齣血量分彆為(50 ±7) min和(8.4 ±3.4)mL;開腹組分彆為(52±7) min和(7.7±2.9)mL,兩組比較,差異均無統計學意義(t=1.291,1.042,P＞0.05).腹腔鏡組患者術中髮現闌尾週圍組織粘連包裹嚴重8例,開腹組11例,兩組比較,差異無統計學意義(P＞0.05).血清學指標鑑測結果顯示:腹腔鏡組患者血清C肽t1～t4分彆為:(62.5±3.3) μ,g/L、(70.7±2.9) μg/L、(86.5±3.4) μg/L、(68.1±2.6) μg/L,開腹組分彆為(63.8±2.8) μg/L、(95.6 ±5.1) μg/L、(106.6±2.3) μg/L、(67.5±4.9)μg/L;腹腔鏡組患者血清胰島素t1～t4分彆為:(13.1±1.0) mU/L、(14.0±1.1) mU/L、(15.1±1.2) mU/L、(13.5±1.1)mU/L,開腹組分彆為(13.3±0.4)mU/L、(15.4±0.6)mU/L、(18.2±0.7) mU/L、(13.5±0.4) mU/L;腹腔鏡組患者血糖t1～t4分彆為:(7.8±1.0) mmol/L、(8.3±1.0) mmol/L、(8.9±1.0) mmol/L、(8.1±1.0) mmol/L,開腹組分彆為(7.8±0.4) mmol/L、(8.7±0.5) mmol/L、(10.1±0.4) mmol/L、(7.9±0.5) mmol/L,上述3種血清學指標變化趨勢不同,兩組比較,差異均有統計學意義(F =378.917,286.602,118.199,P＜0.05).患者術後恢複情況:腹腔鏡組患者術後肛門排氣時間為(1.2 ±0.4)d,開腹組為(1.3 ±0.5)d,兩組比較,差異無統計學意義(t=-0.355,P＞0.05).腹腔鏡組患者術後腹痛持續時間為(1.5±0.6)d,開腹組為(2.5 ±0.7)d,兩組比較,差異有統計學意義(t=-6.367,P＜0.05).腹腔鏡組患者術後傷口感染6例、髮熱10例,開腹組分彆為14例和22例,兩組比較,差異均有統計學意義(P＜0.05).腹腔鏡組患者住院時間為(5.2 ±0.4)d,開腹組為(6.3±0.8)d,兩組比較,差異有統計學意義(t=7.796,P＜0.05).兩組患者均穫得隨訪,中位隨訪時間為8箇月(2～18箇月),均未髮生粘連性腸梗阻,無明顯腹痛、腹脹等不適,無闌尾殘株炎髮生.結論 急診腹腔鏡闌尾切除術與開腹手術比較,對急性化膿性闌尾炎閤併2型糖尿病患者胰腺內分泌功能的影響較小,有利于患者術後康複.
목적 탐토급진복강경란미절제술대급성화농성란미염합병2형당뇨병환자이선내분비공능이급환자예후적영향.방법 회고성분석2012년10월지2014년10월중경의과대학부속영천의원수치적76례급성화농성란미염합병2형당뇨병환자적림상자료.환자균행급진란미절제술,기중41례환자행복강경란미절제술,설위복강경조;35례환자행개복란미절제술,설위개복조.관찰량조환자술중정황;채취매련면역흡부법검측술전15 min(t1)、수술개시후15 min(t2)、수술개시후30 min(t3)、수술결속후30 min(t4)량조환자혈청C태、이도소급혈당적수평;분석환자술후회복정황.술후채용전화수방,수방시간절지2014년12월.부합정태분포적계량자료이(x)±s표시,조간비교채용성조t검험화중복측량방차분석.계수자료적비교채용Fisher학절개솔법.결과 량조환자균순리완성수술,복강경조환자수술시간화술중출혈량분별위(50 ±7) min화(8.4 ±3.4)mL;개복조분별위(52±7) min화(7.7±2.9)mL,량조비교,차이균무통계학의의(t=1.291,1.042,P＞0.05).복강경조환자술중발현란미주위조직점련포과엄중8례,개복조11례,량조비교,차이무통계학의의(P＞0.05).혈청학지표감측결과현시:복강경조환자혈청C태t1～t4분별위:(62.5±3.3) μ,g/L、(70.7±2.9) μg/L、(86.5±3.4) μg/L、(68.1±2.6) μg/L,개복조분별위(63.8±2.8) μg/L、(95.6 ±5.1) μg/L、(106.6±2.3) μg/L、(67.5±4.9)μg/L;복강경조환자혈청이도소t1～t4분별위:(13.1±1.0) mU/L、(14.0±1.1) mU/L、(15.1±1.2) mU/L、(13.5±1.1)mU/L,개복조분별위(13.3±0.4)mU/L、(15.4±0.6)mU/L、(18.2±0.7) mU/L、(13.5±0.4) mU/L;복강경조환자혈당t1～t4분별위:(7.8±1.0) mmol/L、(8.3±1.0) mmol/L、(8.9±1.0) mmol/L、(8.1±1.0) mmol/L,개복조분별위(7.8±0.4) mmol/L、(8.7±0.5) mmol/L、(10.1±0.4) mmol/L、(7.9±0.5) mmol/L,상술3충혈청학지표변화추세불동,량조비교,차이균유통계학의의(F =378.917,286.602,118.199,P＜0.05).환자술후회복정황:복강경조환자술후항문배기시간위(1.2 ±0.4)d,개복조위(1.3 ±0.5)d,량조비교,차이무통계학의의(t=-0.355,P＞0.05).복강경조환자술후복통지속시간위(1.5±0.6)d,개복조위(2.5 ±0.7)d,량조비교,차이유통계학의의(t=-6.367,P＜0.05).복강경조환자술후상구감염6례、발열10례,개복조분별위14례화22례,량조비교,차이균유통계학의의(P＜0.05).복강경조환자주원시간위(5.2 ±0.4)d,개복조위(6.3±0.8)d,량조비교,차이유통계학의의(t=7.796,P＜0.05).량조환자균획득수방,중위수방시간위8개월(2～18개월),균미발생점련성장경조,무명현복통、복창등불괄,무란미잔주염발생.결론 급진복강경란미절제술여개복수술비교,대급성화농성란미염합병2형당뇨병환자이선내분비공능적영향교소,유리우환자술후강복.
Objective To explore the effects of emergent laparoscopic appendectomy on pancreatic endocrine function of patients with acute suppurative appendicitis combined with type 2 diabetes mellitus.Methods The clinical data of 76 patients with suppurative appendicitis combined with type 2 diabetes mellitus who were admitted to the Yongchuan Hospital of Chongqing Medical University between October 2012 and October 2014 were retrospectively analyzed.Among the 76 patients receiving emergent appendectomy,41 patients receiving laparoscopic appendectomy were allocated to the laparoscopy group and 35 patients receiving open appendectomy were allocated to the open surgery group.The intraoperative conditions of patients were observed.The levels of serum C-peptide,insulin and blood glucose at preoperative minute 15 (t1),intraoperative minute 15 (t2),intraoperative minute 30 (t3) and postoperative minute 30 (t4) were detected by enzyme-linked immunosorbent assay (ELISA).The recovery indicators of patients were analyzed.The patients were followed up by telephone interview till December 2014.Measurement data with normal distribution were presented as (x) ± s.Comparison between groups was analyzed by the independent samples t-test and repeated measures ANOVA.Count data were compared by the Fisher exact probability.Results All the patients underwent successfully the operations.The operation time and the volume of intraoperative blood loss in the laparoscopy group were (50 ± 7) minutes and (8.4 ± 3.4) mL,which were not significantly different from (52 ± 7) minutes and (7.7 ± 2.9) mL in the open surgery group (t =1.291,1.042,P ＞ 0.05).Serious adhesions of tissues around the appendix in the laparoscopy group were detected in 8 patients,which was not significantly different from 11 patients in the open surgery group (P ＞ 0.05).The results of the serologic test showed that the levels of serum C-peptide between t1 and t4 were (62.5 ±3.3) μg/L,(70.7 ±2.9) μg/L,(86.5 ± 3.4) μg/L and (68.1 ± 2.6) μg/L in the laparoscopy group and (63.8 ± 2.8) μg/L,(95.6 ± 5.1) μg/L,(106.6 ± 2.3) μg/L and (67.5 ± 4.9) μg/L in the open surgery group,respectively.The levels of insulin between t1 and t4 were (13.1 ± 1.0) mU/L,(14.0 ± 1.1) mU/L,(15.1 ± 1.2) mU/L and (13.5 ± 1.1) mU/L in the laparoscopy group and (13.3 ± 0.4) mU/L,(15.4 ± 0.6) mU/L,(18.2 ± 0.7) mU/L and (13.5 ± 0.4)mU/L in the open surgery group,respectively.The levels of blood glucose between t1 and t4 were (7.8 ± 1.0) mmol/L,(8.3 ± 1.0) mmol/L,(8.9 ± 1.0) mmol/L and (8.1 ± 1.0) mmol/L in the laparoscopy group and (7.8 ± 0.4) mmol/L,(8.7 ± 0.5) mmol/L,(10.1 ± 0.4) mmol/L and (7.9 ±0.5) mmol/L in the open surgery group,respectively.There were significant differences in the changing trends of serum C-peptide,insulin and blood glucose between the 2 groups (F =378.917,286.602,118.199,P ＜ 0.05).The time to anal exsufflation in the laparoscopy group and in the open surgery group were (1.2 ± 0.4) days and (1.3 ± 0.5) days,with no significant difference between the 2 groups (t =-0.355,P ＞ 0.05).The duration of postoperative abdominal pain in the laparoscopy group was(1.5 ± 0.6)days,which was significantly different from (2.5 ± 0.7) days in the open surgery group (t =-6.367,P ＜ 0.05).The wound infection and fever in the laparoscopy group were detected in 6 and 10 patients,which were significantly different from 14 and 22 patients in the open surgery group (P ＜ 0.05).The duration of hospital stay in the laparoscopy group and in the open surgery group were (5.2 ± 0.4) days and (6.3 ± 0.8) days,respectively,showing a significant difference between the 2 groups (t =7.796,P ＜ 0.05).All the patients were followed up for a median time of 8 months (range,2-18 months),without adhesive intestinal obstruction,abdominal pain,abdominal distension and appendix stump inflammation.Conclusion The emergency laparoscopic appendectomy compared with the open surgery would be less affected on pancreatic endocrine function of patients with acute suppurative appendicitis combined with type 2 diabetes mellitus,with an advantage of better postoperative recovery.
