急诊腹腔镜阑尾切除术对2型糖尿病患者胰腺内分泌功能的影响
发布时间：2018-12-13 01:39
【摘要】：目的探讨急诊腹腔镜阑尾切除术对2型糖尿病患者胰腺内分泌功能的影响以及对患者的预后。方法 回顾性分析了2012年10月-2014年10月在重庆医科大学附属永川医院收治的76例合并2型糖尿病的急性化脓性阑尾炎患者的临床资料。这些患者都施行了阑尾切除术,施行腹腔镜阑尾切除术的患者有41例,设为腹腔镜组；施行开腹阑尾切除术的患者有35例,设为开腹组。分别观察两个组的患者在手术中的情况；采取酶联免疫吸附法来监测两组患者术前15min(t1)手术开始后15min (t2)、30min (t3)、手术结束后30min(t4)的血清C肽、胰岛素及血糖的水平；分析患者预后指标。出院后电话随访,随访时间截至2014年12月。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。计数资料的比较均采用的是x2检验或Fisher's确切概率法。结果两组患者完成手术,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,差异无统计学意义(t=-1.291,1.042,p0.05)。腹腔镜组发现术中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(p0.05)。血清学指标的监测结果显示：腹腔镜组患者血清C肽t1-t4分别为：(62.5±3.3)ng/mL.(70.7±2.9) ng/mL.(86.5±3.4)ng/mL.(68.1±2.6)ng/mL,开腹组分别为(63.8+2.8) ng/mL. (95.6±5.1)ng/mL. (106.6±2.3)ng/mL. (67.5±4.9)ng/mL；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±O.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,两组差异有统计学意义(F=378.917,286.602,118.199,P0.05)。患者术后恢复情况：腹腔镜组患者在术后的腹痛持续时间为(1.5±0.6)d,开腹组为(2.5±0.7)d,两组手术患者差异有统计学意义(t=-6.367,p0.05)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(p0.05)。腹腔镜组患者术后肛门排气时间是(1.2+0.4)d,开腹组是(1.3+0.5),两组比较,差异无统计学意义(p0.05)。腹腔镜组患者住院时间是(5.2±4.2)d,开腹组是(6.3±0.8)d,两组手衍患者比较,差异有统计学意义(t=7.796,p0.05)。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传统的开腹手术比较,对2型糖尿病患者胰腺内分泌功能的影响较小,在术后恢复方面表现更好。
[Abstract]:Objective to investigate the effect of emergency laparoscopic appendectomy on pancreatic endocrine function and prognosis of type 2 diabetes mellitus. Methods the clinical data of 76 patients with acute suppurative appendicitis complicated with type 2 diabetes were analyzed retrospectively from October 2012 to October 2014 in Yongchuan Hospital affiliated to Chongqing Medical University. All patients underwent appendectomy, 41 patients underwent laparoscopic appendectomy, and 35 patients underwent open appendectomy. The patients in the two groups were observed during the operation. Enzyme linked immunosorbent assay (Elisa) was used to monitor the serum levels of C peptide, insulin and blood glucose in 15min (T1), 30min (T3) and 30min (t4) after operation, and the prognostic indexes were analyzed. All patients were followed up by telephone until December 2014. The measurement data of normal distribution were expressed as x 卤s, and the comparison between groups was performed by group t test and repeated measurement analysis of variance (ANOVA). The count data are compared by X 2 test or Fisher's exact probability method. Results the operative time and blood loss in laparoscopic group were (50 卤7) min and (8.44 4) mL;, respectively. There was no significant difference between the open group (52 卤7) min and 7. 7 2. 9 mL, group (t = 1. 291 卤1. 042, p 0. 05). There were 8 cases of severe periappendiceal adhesions in laparoscopic group and 11 cases of open group. There was no significant difference between the two groups (p0.05). Serum C-peptide t1-t4 was (62.5 卤3.3) ng/mL., (70.7 卤2.9) ng/mL., (86.5 卤3.4) ng/mL. and (68.1 卤2.6) ng/mL, respectively. The open group was (63. 8. 8) ng/mL.. (95.6 卤5.1) ng/mL. (106.6 卤2.3) ng/mL. (67.5 卤4.9) ng/mL; The serum insulin t1-t4 in the laparoscopic group was (13.1 卤1.0) mU/L. (14.01.1) mU/L. (15.1 卤1.2) mU/L. (13.5 1.1) mU/L, respectively. The open group was (13.30.4) mU/L. (15.4 卤O.6) mU/L. (18.2 卤0.7) mU/L. (13.5 卤0.4) mU/L;, respectively. The t1-t4 of blood glucose in the laparoscopic group was (7.8 1.0) mmol/L. (8.3 1.0) mmol/L. (8.9 1.0) mmol/L. (8.1 1.0) mmol/L, respectively. The three serological indexes in the open group were (7.80.4) mmol/L. (8.7 0.5) mmol/L. (10.10 0.4) mmol/L. (7.9 0.5) mmol/L, respectively. The difference between the two groups was statistically significant (FG 378.917286.602118.199P0.05). Postoperative recovery: the duration of abdominal pain was (1.5 卤0.6) days in the laparoscopic group and (2.5 卤0.7) days in the open group. There was a significant difference between the two groups (t = 6.367). P0.05) there were 6 cases of postoperative wound infection and 10 cases of fever in the laparoscopic group, and 14 cases and 22 cases in the open group, respectively. The difference between the two groups was statistically significant (p0.05). The postoperative time of anal exhaust was (1.2 0.4) d in the laparoscopic group and (1.3 0.5) in the open group. There was no significant difference between the two groups (p0.05). The hospital stay was (5.2 卤4.2) days in the laparoscopy group and (6.3 卤0.8) days in the open group. The difference between the two groups was statistically significant (t = 7.796, p 0.05). The median follow-up time was 8 months (2 ~ 18 months). There was no adhesive intestinal obstruction, no obvious abdominal pain, abdominal distention, and no appendicitis. Conclusion the effect of emergency laparoscopic appendectomy on pancreatic endocrine function in patients with type 2 diabetes mellitus is less than that of traditional laparoscopic appendectomy, and it is better in postoperative recovery.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R587.1
本文编号：2375633
[Abstract]:Objective to investigate the effect of emergency laparoscopic appendectomy on pancreatic endocrine function and prognosis of type 2 diabetes mellitus. Methods the clinical data of 76 patients with acute suppurative appendicitis complicated with type 2 diabetes were analyzed retrospectively from October 2012 to October 2014 in Yongchuan Hospital affiliated to Chongqing Medical University. All patients underwent appendectomy, 41 patients underwent laparoscopic appendectomy, and 35 patients underwent open appendectomy. The patients in the two groups were observed during the operation. Enzyme linked immunosorbent assay (Elisa) was used to monitor the serum levels of C peptide, insulin and blood glucose in 15min (T1), 30min (T3) and 30min (t4) after operation, and the prognostic indexes were analyzed. All patients were followed up by telephone until December 2014. The measurement data of normal distribution were expressed as x 卤s, and the comparison between groups was performed by group t test and repeated measurement analysis of variance (ANOVA). The count data are compared by X 2 test or Fisher's exact probability method. Results the operative time and blood loss in laparoscopic group were (50 卤7) min and (8.44 4) mL;, respectively. There was no significant difference between the open group (52 卤7) min and 7. 7 2. 9 mL, group (t = 1. 291 卤1. 042, p 0. 05). There were 8 cases of severe periappendiceal adhesions in laparoscopic group and 11 cases of open group. There was no significant difference between the two groups (p0.05). Serum C-peptide t1-t4 was (62.5 卤3.3) ng/mL., (70.7 卤2.9) ng/mL., (86.5 卤3.4) ng/mL. and (68.1 卤2.6) ng/mL, respectively. The open group was (63. 8. 8) ng/mL.. (95.6 卤5.1) ng/mL. (106.6 卤2.3) ng/mL. (67.5 卤4.9) ng/mL; The serum insulin t1-t4 in the laparoscopic group was (13.1 卤1.0) mU/L. (14.01.1) mU/L. (15.1 卤1.2) mU/L. (13.5 1.1) mU/L, respectively. The open group was (13.30.4) mU/L. (15.4 卤O.6) mU/L. (18.2 卤0.7) mU/L. (13.5 卤0.4) mU/L;, respectively. The t1-t4 of blood glucose in the laparoscopic group was (7.8 1.0) mmol/L. (8.3 1.0) mmol/L. (8.9 1.0) mmol/L. (8.1 1.0) mmol/L, respectively. The three serological indexes in the open group were (7.80.4) mmol/L. (8.7 0.5) mmol/L. (10.10 0.4) mmol/L. (7.9 0.5) mmol/L, respectively. The difference between the two groups was statistically significant (FG 378.917286.602118.199P0.05). Postoperative recovery: the duration of abdominal pain was (1.5 卤0.6) days in the laparoscopic group and (2.5 卤0.7) days in the open group. There was a significant difference between the two groups (t = 6.367). P0.05) there were 6 cases of postoperative wound infection and 10 cases of fever in the laparoscopic group, and 14 cases and 22 cases in the open group, respectively. The difference between the two groups was statistically significant (p0.05). The postoperative time of anal exhaust was (1.2 0.4) d in the laparoscopic group and (1.3 0.5) in the open group. There was no significant difference between the two groups (p0.05). The hospital stay was (5.2 卤4.2) days in the laparoscopy group and (6.3 卤0.8) days in the open group. The difference between the two groups was statistically significant (t = 7.796, p 0.05). The median follow-up time was 8 months (2 ~ 18 months). There was no adhesive intestinal obstruction, no obvious abdominal pain, abdominal distention, and no appendicitis. Conclusion the effect of emergency laparoscopic appendectomy on pancreatic endocrine function in patients with type 2 diabetes mellitus is less than that of traditional laparoscopic appendectomy, and it is better in postoperative recovery.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R587.1
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