糖尿病患者胆囊切除术后胃轻瘫临床特征分析

目的:探讨糖尿病患者胆囊切除术后胃轻瘫的临床特征。方法:回顾性分析2017年1月～2019年1月收治的162例合并糖尿病的胆囊病变患者接受胆囊切除术的临床和随访资料,统计糖尿病患者胆囊切除术后胃轻瘫的临床症状,对比胃轻瘫和无胃轻瘫人口学特征,糖尿病、胆囊病变和手术相关指标。结果:本研究中162例糖尿病胆囊切除患者25例术后发生胃轻瘫(归为胃轻瘫组),137例术后未发生胃轻瘫(归为无胃轻瘫组),胃轻瘫发生率为15.4%(25/162),其中轻、中、重度各占48.0%(12/25)、32.0%(8/25)和20.0%(5/25),主要临床症状由高到低依次为恶心(96.0%,24/25)、呕吐(88.0%,22/25)、上腹痛(76.0%,19/25)、腹胀或腹部不适(72.0%,18/25),餐后饱胀感、早饱(64.0%,16/25)。与无胃轻瘫组比较,胃轻瘫组老年、女性、1型糖尿病所占比例较高,糖尿病病程更长,体质量指数、空腹血糖、糖化血红蛋白水平偏高,差异有统计学意义(P0.05)。两组糖尿病用药情况、胆囊病变种类、手术方式、手术时间、术中出血量等指标比较,差异无统计学意义(P0.05)。结论:糖尿病患者胆囊切除术后胃轻瘫通常为轻、中度,最常见的症状为恶心、呕吐和上腹痛,老年、女性、1型糖尿病、糖尿病病程长和血糖控制不佳的糖尿病患者胆囊切除术后发生胃轻瘫风险较高。

Clinical characteristics of gastroparesis after cholecystectomy in diabetic patients.

Objective To investigate the clinical characteristics of gastroparesis after cholecystectomy in diabetic patients. Methods The clinical and follow-up data of 162 patients with diabetic cholecystectomy from January 2017 to May 2019 were retrospectively analyzed. Among them, 25 patients had gastroparesis (gastroparesis group) and 137 patients had no gastroparesis (no gastroparesis group). The clinical symptoms of gastroparesis after cholecystectomy in diabetic patients were analyzed. The demographic characteristics, diabetes mellitus, gallbladder lesions and surgical related indicators were compared between gastroparesis group and non-gastroparesis group. Results The incidence of gastroparesis after cholecystectomy was 15.4% (25/162), of which 48% (12/25), 32% (8/25) and 20% (5/25) were mild, moderate and severe. The main clinical symptoms were nausea (96%, 24/25), vomiting (88%, 22/25), upper abdominal pain (76%, 19/25), abdominal distension or abdominal discomfort (72%, 18/25), postprandial fullness/early satiety (64%, 16/25). Compared with non-gastroparesis group, the proportion of elderly, female and type 1 diabetes mellitus in gastroparesis group was higher, BMI index, course of diabetes mellitus, fasting blood sugar and glycosylated hemoglobin levels were higher, the difference was statistically significant (P < 0.05). There was no significant difference in diabetes medication, types of gallbladder lesions, operation methods, operation time and intraoperative bleeding volume between the two groups (P > 0.05). Conclusion Gastric paralysis after cholecystectomy in diabetic patients is usually mild to moderate. The main clinical symptoms are nausea, vomiting and epigastric pain. The risk of gastroparesis after cholecystectomy is high in elderly, female, type 1 diabetes mellitus, diabetic patients with long duration and poor glycemic control.