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目的探讨分析合并糖尿病的老年胃癌患者的临床特点、手术方式、手术治疗的注意事项及术后处理措施等。方法回顾性分析2006年3月-2011年12月在亳州市人民医院住院接受手术治疗的年龄大于70岁的56例合并糖尿病的老年胃癌患者的临床资料。结果本组行近端胃切除20例,远端胃切除25例,全胃切除11例。消化道重建方式包括:胃-食管吻合术17例、毕Ⅰ式8例、毕Ⅱ式17例、Roux-en-Y吻合14例。术后发生并发症患者12例(21.43%),其中肺部感染4例,ARDS 1例,腹腔感染1例,切口感染2,切口裂开2例,吻合口漏1例、胃肠功能紊乱3例,无低血糖及糖尿病酮症酸中毒。未经控制的糖尿病患者术后并发症的发生率明显高于血糖满意控制的糖尿病患者,差异有统计学意义(P<0.05)。结论合并糖尿病的老年患者临床上应根据老年胃癌患者的临床特点,围术期严格控制血糖,严格掌握手术适应证和禁忌症,加强围手术期的处理,合理选择术式,提高手术的安全性。
Objective To investigate the clinical features, surgical procedures, precautions of surgical treatment and postoperative management of elderly patients with diabetes mellitus. Methods The clinical data of 56 elderly gastric cancer patients with diabetes mellitus older than 70 years who were hospitalized in Bozhou People ’s Hospital from March 2006 to December 2011 were retrospectively analyzed. Results The group of proximal gastrectomy in 20 cases, distal gastrectomy in 25 cases, total gastrectomy in 11 cases. Gastrointestinal reconstruction included 17 cases of gastric-esophageal anastomosis, 8 cases of complete type Ⅰ, 17 cases of complete Ⅱ, and 14 cases of Roux-en-Y anastomosis. There were 12 patients (21.43%) with postoperative complications, including 4 cases of pulmonary infection, 1 case of ARDS, 1 case of abdominal infection, 2 cases of incision infection, 2 cases of incision rupture, 1 case of anastomotic leakage, 3 cases of gastrointestinal disorders Cases, no hypoglycemia and diabetic ketoacidosis. The incidence of postoperative complications in uncontrolled diabetic patients was significantly higher than that of diabetic patients with satisfactory control of blood glucose (P <0.05). Conclusion The elderly patients with diabetes mellitus should be clinically based on the clinical features of elderly patients with gastric cancer, perioperative strict control of blood glucose, strict indications and contraindications for surgical treatment, to strengthen perioperative management, rational selection of surgical procedures to improve the safety of surgery .