【摘要】：目的探討急診腹腔鏡闌尾切除術(shù)對2型糖尿病患者胰腺內(nèi)分泌功能的影響以及對患者的預(yù)后。方法 回顧性分析了2012年10月-2014年10月在重慶醫(yī)科大學(xué)附屬永川醫(yī)院收治的76例合并2型糖尿病的急性化膿性闌尾炎患者的臨床資料。這些患者都施行了闌尾切除術(shù),施行腹腔鏡闌尾切除術(shù)的患者有41例,設(shè)為腹腔鏡組；施行開腹闌尾切除術(shù)的患者有35例,設(shè)為開腹組。分別觀察兩個組的患者在手術(shù)中的情況；采取酶聯(lián)免疫吸附法來監(jiān)測兩組患者術(shù)前15min(t1)手術(shù)開始后15min (t2)、30min (t3)、手術(shù)結(jié)束后30min(t4)的血清C肽、胰島素及血糖的水平；分析患者預(yù)后指標(biāo)。出院后電話隨訪,隨訪時間截至2014年12月。正態(tài)分布的計(jì)量資料以x±s表示,組間比較采用成組t檢驗(yàn)和重復(fù)測量方差分析。計(jì)數(shù)資料的比較均采用的是x2檢驗(yàn)或Fisher's確切概率法。結(jié)果兩組患者完成手術(shù),腹腔鏡組患者手術(shù)時間和術(shù)中出血量分別為(50±7)min和(8.4+3.4)mL；開腹組分別為(52±7)min和7.7+2.9)mL,兩組比較,差異無統(tǒng)計(jì)學(xué)意義(t=-1.291,1.042,p0.05)。腹腔鏡組發(fā)現(xiàn)術(shù)中闌尾周圍組織粘連包裹嚴(yán)重8例,開腹組11例,兩組比較,差異無統(tǒng)計(jì)學(xué)意義(p0.05)。血清學(xué)指標(biāo)的監(jiān)測結(jié)果顯示：腹腔鏡組患者血清C肽t1-t4分別為：(62.5±3.3)ng/mL.(70.7±2.9) ng/mL.(86.5±3.4)ng/mL.(68.1±2.6)ng/mL,開腹組分別為(63.8+2.8) ng/mL. (95.6±5.1)ng/mL. (106.6±2.3)ng/mL. (67.5±4.9)ng/mL；腹腔鏡組患者血清胰島素t1-t4分別為：(13.1±1.0)mU/L.(14.0+1.1) mU/L.(15.1±1.2)mU/L.(13.5+1.1)mU/L,開腹組分別為(13.3+0.4) mU/L. (15.4±O.6)mU/L. (18.2±0.7)mU/L. (13.5±0.4)mU/L；腹腔鏡組患者血糖t1-t4分別為：(7.8+1.0)mmol/L. (8.3+1.0) mmol/L.(8.9+1.0)mmol/L.(8.1+1.0)mmol/L,開腹組分別為(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(xué)指標(biāo)變化趨勢不同,兩組差異有統(tǒng)計(jì)學(xué)意義(F=378.917,286.602,118.199,P0.05)。患者術(shù)后恢復(fù)情況：腹腔鏡組患者在術(shù)后的腹痛持續(xù)時間為(1.5±0.6)d,開腹組為(2.5±0.7)d,兩組手術(shù)患者差異有統(tǒng)計(jì)學(xué)意義(t=-6.367,p0.05)腹腔鏡組患者術(shù)后傷口感染6例、發(fā)熱10例,開腹組分別為14例和22例,兩組比較,差異均有統(tǒng)計(jì)學(xué)意義(p0.05)。腹腔鏡組患者術(shù)后肛門排氣時間是(1.2+0.4)d,開腹組是(1.3+0.5),兩組比較,差異無統(tǒng)計(jì)學(xué)意義(p0.05)。腹腔鏡組患者住院時間是(5.2±4.2)d,開腹組是(6.3±0.8)d,兩組手衍患者比較,差異有統(tǒng)計(jì)學(xué)意義(t=7.796,p0.05)。兩組患者均獲得隨訪,中位隨訪時間為8個月(2～18個月),均未發(fā)生粘連性腸梗阻,無明顯腹痛、腹脹等不適,無闌尾殘株炎發(fā)生。結(jié)論急診腹腔鏡闌尾切除術(shù)與傳統(tǒng)的開腹手術(shù)比較,對2型糖尿病患者胰腺內(nèi)分泌功能的影響較小,在術(shù)后恢復(fù)方面表現(xiàn)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 鹵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 鹵7) min and (8.44 4) mL;, respectively. There was no significant difference between the open group (52 鹵7) min and 7. 7 2. 9 mL, group (t = 1. 291 鹵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 鹵3.3) ng/mL., (70.7 鹵2.9) ng/mL., (86.5 鹵3.4) ng/mL. and (68.1 鹵2.6) ng/mL, respectively. The open group was (63. 8. 8) ng/mL.. (95.6 鹵5.1) ng/mL. (106.6 鹵2.3) ng/mL. (67.5 鹵4.9) ng/mL; The serum insulin t1-t4 in the laparoscopic group was (13.1 鹵1.0) mU/L. (14.01.1) mU/L. (15.1 鹵1.2) mU/L. (13.5 1.1) mU/L, respectively. The open group was (13.30.4) mU/L. (15.4 鹵O.6) mU/L. (18.2 鹵0.7) mU/L. (13.5 鹵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 鹵0.6) days in the laparoscopic group and (2.5 鹵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 鹵4.2) days in the laparoscopy group and (6.3 鹵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.
【學(xué)位授予單位】：重慶醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R587.1

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