胰腺癌合并糖尿病的围手术期处理

我院１９８８年１月至１９９７年１２月行胰腺癌手术２０８例,其中合并糖尿病３９例,占１８．８％。现就胰腺癌与糖尿病的关系及围手术期糖尿病的治疗讨论如下。１临床资料胰腺癌合并糖尿病３９例,其中男性２９例,女性１０例。年龄４７～７４岁,平均５９岁。首发症状...     

胰腺癌合并糖尿病围手术期管理研究进展

胰腺癌合并糖尿病临床常见,两者关系密切,相互影响.糖尿病可使患者代谢紊乱,机体修复及抗感染能力下降,增加胰腺癌手术的危险性.而胰腺手术本身可引起胰腺内分泌功能损害,加重糖尿病病情,这一系列的过程可导致术后并发症及死亡率的增加.因此,针对胰腺癌合并糖尿病的临床特征,通过合理饮食指导及营养管理,有效地控制围手术期血糖水平,防止感染,降低术后并发症,胰腺癌合并糖尿病病人可以取得满意的治疗效果.     

食管癌合并糖尿病的围手术期处理

回顾性总结 2 3例食管癌合并糖尿病的处理经验。术前、术中、术后均应用普通胰岛素 (RI)控制糖尿病 ,不限制糖的摄入 ,按比例应用RI ,并根据尿糖的测定追加RI ,使血糖略高于正常水平 ,尿糖控制在 (± )～ ( )为安全措施。研究提示 ,术前常规检查血糖 ,针对糖尿病采取妥善的围手术期处理明显减少食管癌合并糖尿病患者的术后并发症 ,RI的合理应用是治疗成功的关键 ,治疗过程中应重点加强对糖尿病的处理。     

34例食管癌合并糖尿病患者围手术期的治疗体会

回顾性总结了食管癌合并糖尿病围手术期的治疗经验，其要点包括：术前常规查血糖，术后用末梢血糖检测仪监测血糖，尿糖试纸监测尿糖，应用胰岛素调整血糖，给予充足的热量，预防酸碱平衡失调及电解质紊乱，采取妥善的处理方法可减少食管癌的术后并发症。     

妇科肿瘤合并糖尿病的围手术期处理

目的：探讨妇科肿瘤病人合并糖尿病的围手术期处理。方法：通过回顾20例妇科肿瘤病人合并糖尿病的治疗经过，分析手术前、中、后治疗方法，加以总结。结果：20例中良性肿瘤合并糖尿病13例，恶性肿瘤合并糖尿病7例。肿瘤发生前糖尿病诊断已成立者5例，15例为住院后术前检查所发现。20例术后刀口7天拆线，均甲级愈合。术前、术中、术后均用普通胰岛素控制糖尿病、补糖以5％的等渗液为主。结论：积极进行围手术期管理确保血糖、尿糖稳定在允许的范围内是手术成功的重要措施，并可减少并发症的发生。     

合并糖尿病的肿瘤患者围手术期处理

恶性肿瘤是严重危害人民生命健康的常见多发病，其发病率亦呈缓慢上升趋势。手术治疗是目前肿瘤治疗最有效的手段之一。近年来随着糖尿病发病的增加，对合并糖尿病的肿瘤患者进行合理的，有效的围手术期处理就显得十分重要，现就有关问题简要综述如下：     

妇科肿瘤合并糖尿病的围手术期处理

目的　探讨妇科肿瘤病人合并糖尿病的围手术期处理。方法　通过回顾 2 0例妇科肿瘤病人合并糖尿病的治疗经过 ,分析手术前、中、后治疗方法 ,加以总结。结果　 2 0例中良性肿瘤合并糖尿病 13例 ,恶性肿瘤合并糖尿病 7例。肿瘤发生前糖尿病诊断已成立者 5例 ,15例为住院后术前检查所发现。 2 0例术后刀口 7天拆线 ,均甲级愈合。术前、术中、术后均用普通胰岛素控制糖尿病 ,补糖以 5 %的等渗液为主。结论　积极进行围手术期管理确保血糖、尿糖稳定在允许的范围内是手术成功的重要措施 ,并可减少并发症的发生。     

食管癌合并糖尿病患者围手术期护理

目的:探讨食管癌合并糖尿病患者的围手术期护理方法.方法:对48例食管癌合并糖尿病患者围手术期的护理措施进行分析与总结.结果:48例患者均顺利完成手术治疗,术后发生低血糖1例,肺部感染2例,无死亡病例,平均住院17天,均康复出院.结论:通过有效地围手术期护理,可提高食管癌合并糖尿病患者手术成功率,减少并发症,促进患者康复.     

老年胃癌合并糖尿病95例的外科治疗

目的探讨合并糖尿病的老年胃癌围手术期的处理。方法对外科治疗合并糖尿病的95例老年胃癌患者的临床资料进行回顾性分析。结果95例均行择期手术，术后共发生各类并发症27例次，手术死亡3例，其余患者均安全度过围手术期。结论严格控制血糖和尿糖是老年胃癌合并糖尿病患者安全度过围手术期的关键。     

大肠癌合并糖尿病的外科治疗

目的　探讨大肠癌合并糖尿病病人的外科治疗措施。方法　 1993年 2月～ 1998年 8月 ,外科治疗的 43例大肠癌伴糖尿病病人作回顾性分析。结果　 43例均行择期手术 ,术后并发症发生率 :吻合口瘘占 9 3 % (4 /4 3 ) ,切口感染 2 5 6% (11/4 3 ) ,腹腔感染7 0 % (3 /4 3 ) ,骶前间隙积脓 4 7% (2 /4 3 ) ,泌尿系感染 2 3 % (1/4 3 )。术后平均住院 2 2天 ,无围手术期死亡病例。结论　大肠癌合并糖尿病病人只要围手术期严格控制血糖 ,选择合理的手术方式 ,完全可以达到理想的外科治疗效果     

食管,贲门癌伴糖尿病患者的围手术期处理

目的：探讨食管贲门癌合并糖尿病的围手术期处理。方法：回顾性总结15例食管贲门癌合并糖尿病的治疗经验。结果：15例中食管癌12例，贲门癌3例；术前伴慢性阻塞性肺部疾病者2例，伴心血管疾病者9例；发现癌肿时糖尿病诊断已成立者6例，另9例为术前检查所发现，空腹血糖5．9－14．6mmol／L；根治性切除11例，姑息性切除4例，切除率100％；术后胸部切口感染5例；发生低血糖体克1例；全组除1例死于糖尿病高渗性昏迷外，其余均顺利／经相应处理后渡过手术期。术前、术中、术后均用普通胰岛素控制糖尿病，补糖以5％的等渗液体为主，按1u普通胰岛素：5g糖的比例补液，并按尿糖一个"＋"：3u胰岛素的剂量追加，使患者尿糖控制在"＋-＋＋"、血糖保持在略高于正常的水平。术后7天开始进食后逐渐改用口服降糖药。结论：食管责门癌合并糖尿病系一较严重且常见的临床情况，术后并发症发生率高，应予以重视，胰岛素的合理应用是治疗成功的关键。     

Type 2 Diabetes Mellitus and Characteristics of Breast Cancer in China

Studies have showed an association between type 2 diabetes and breast cancer in Western countries. The association should be confirmed in an Asian population which has a lower incidence of breast cancer. Our study aimed to compare the clinicopathologic characteristics of breast cancers in women with and without type 2 diabetes mellitus in China. Each group included 143 cases, similar in parity, body mass index, family history, mode of diagnosis, menarche age and hormone receptors except for progesterone receptor (PR). The diabetic patients were older, with a mean age of 58.3±10 years and the percentage of postmenopausal patients was 52%, which was higher than non-diabetic patients. Significant differences were found in tumor stage, the amounts of lymph node and with metastasis, these persisting after adjustment for age. Furthermore, a positive association with higher TNM status and PR negative rate was noticed in premenopausal but not postmenopausal diabetic patients. Our results indicate that type 2 diabetes mellitus is a negative prognostic factor for breast cancer, especially in premenopausal women.     

Diabetes Mellitus Increases the Risk of Bladder Cancer: An Updated Meta-analysis

Purpose: Studies have indicated that diabetes mellitus (DM) is a risk factor for bladder cancer; however,not all evidence supports this conclusion. The aim of this meta-analysis was to collate and evaluate all primaryobservational studies investigating the risk of bladder cancer associated with DM. Methods: The PubMed andGoogle Scholar databases were searched to identify studies that estimated the association of DM and bladdercancer. Summary effect estimates were derived using a random-effects meta-analysis model. Results: A totalof 23 studies (8 case-control studies, 15 cohort studies) including 643,683 DM and 4,819,656 non-DM caseswere identified. Analysis of all studies showed that DM was associated with an increased risk of bladder cancercompared with non-DM overall (OR=1.68, 95% CI 1.32-2.13). Analysis of subgroups demonstrated this to bethe case in both case-control studies (OR=1.59, 95% CI 1.28-1.97, I2=58%) and cohort studies (RR=1.70, 95%CI 1.23-2.33, I2=96%). There was no gender difference in DM-associated bladder cancer risk. Bladder cancerrisk was increased in Asia and the North America region, but not in Europe. Furthermore, DM-associatedbladder cancer risk was obviously higher in Asia than North America and Europe or in those with Caucasianethnicity. With extension of follow-up time, the bladder cancer risk was not increased for the patients with DM.Conclusions: This meta-analysis provided further evidence supporting theDM association with a significantlyhigher risk of bladder cancer obtained from observational studies.     

Diabetes Mellitus Reduces Prostate Cancer Risk - No Function of Age at Diagnosis or Duration of Disease

Background: Prior studies examining the relation between diabetes mellitus (DM) and prostate cancer riskhave reported controversial findings. We examined this association by conducting a detailed meta-analysis of thepeer-reviewed literature. Methods: A comprehensive search for articles of MEDLINE and EMBASE databasesand bibliographies of retrieved articles published up to November, 2012 was performed. Methodological qualityassessment of the trials was based on the Newcastle-Ottawa Scaleq and the meta-analysis was performed usingSTATA 12.0. Dose-response regression was conducted with SPSS 19.0. Results: We included 29 studies in themeta-analysis (13 case-control studies, 16 cohort studies), and found an inverse association between DM andprostate cancer (relative risk (RR) 0.84, 95% confidence interval (CI), 0.78-0.91). An inverse association wasalso observed in non-Asian populations (RR 0.81, 95% CI 0.76-0.87) and population-based studies (RR 0.80,95% CI 0.77-0.91). No statistical significance was found of the association between prostate cancer risk and theduration of DM (p=0.338), and risk seemed not related with the age of DM diagnosis. Conclusions: This studysuggested an inverse relationship between DM and prostate cancer, but without links to duration of disease orage of diagnosis.     

Diabetes Mellitus and Prostate Cancer Risk in Asian Countries: a Meta-analysis

Background/Aims: Diabetes mellitus (DM) is widely considered to be associated with risk of cancer, but studiesinvestigating the association between DM and prostate cancer in Asian countries have reported inconsistentfindings. We examined this association by conducting a detailed meta-analysis of studies published on the subject.Methods: Cohort or case-control studies were identified by searching Pubmed, Embase and Wanfang databasesthrough May 30, 2012. Pooled relative risk (RR) with its corresponding 95% confidence interval (95% CI) werecalculated using the random-effects model. Subgroup analyses were performed by the study type. Results: Finally,we identified 7 studies (four cohort studies and three case-control studies) with a total of 1,751,274 subjectsfrom Asians. DM was associated with an increased risk of prostate cancer in Asians (unadjusted RR= 2.82, 95%CI 1.73–4.58, P < 0.001; adjusted RR= 1.31, 95% CI 1.12–1.54, P = 0.001). Subgroup analyses by study designfurther confirmed an obvious association. Conclusion: Findings from this meta-analysis strongly support thatdiabetes is associated with an increased risk of prostate cancer in Asians.     

Diabetes Mellitus and HbA1c Levels Associated with High Grade Prostate Cancer

Pirpose: The aim of this study to analyze the association between history of diabetes mellitus (DM) with riskof prostate cancer (PCa) and cancer grade among men undergoing radical prostatectomy for PCa. Materialsand Methods: 50 patients with DM and 50 patients without DM who undervent radical prostatectomy (RP)were included in the study. Age at biopsy, height, weight, digital rectal examination (DRE), pre-biopsy PSAlevels, prostate volume, histopathologic diagnosis after surgery and gleason scores were collected data from allpatients. Histologic material obtained at biopsy was given a Gleason score; tumours with a Gleason score ≥7 wereconsidered high grade and <7 were considered low grade. Results: The mean age at the time of biopsy was 63.7in patients with DM and 61.6 in patients without DM. Diabetic men had significantly lower PSA levels (p=0.01).Mean PSA level 7.04±2.85 in patients with DM and 8.7±2.86 in patients without DM, respectively. Also, diabeticmen had higher RP tumor grade than men without DM (p=0.04). We found that HbA1c levels were higher inpatients who have high grade prostate cancer (p<0.05). Conclusions: Diabetic men undergoing RP have lowerPSA levels and have significantly higher grade PCa. We must be careful for screening PCa in patients with DM.Although the patients had lower PSA levels, they might have high grade disease.     

Causative Relationship between Diabetes Mellitus and Breast Cancer in Various Regions of Saudi Arabia: An Overview

The unwarranted connection between diabetes mellitus and breast cancer has gained new ground in recentyears. Breast cancer in Saudi females accounts for approximately 21% of all cancers and the prevalence ofdiabetes mellitus (DM) in Saudi females is also 21.5%. DM is diagnosed in the age group of 30+ years withpossible exposure to predisposing factors like hyperinsulinemia and obesity at younger age. Further, 12% of thebreast cancer cases are diagnosed in the young females aged 20-34 years. Despite the readily available access tohealthcare facilities in the Kingdom, a large number of diabetics, approximately 27.9%, were unaware of havingdiabetes mellitus. This subpopulation is quite susceptible of developing breast cancer at later age. This reviewdiscusses common etiological and predisposing factors for breast cancer and diabetes, regional distribution andpossible correlation of diabetes and cancer in Saudi Arabia.     

Diabetes Mellitus and Renal Cell Carcinoma - A Hospital Based Study from Kathmandu Valley

Objective: To diagnose renal cell carcinoma at early stages and for better prognosis , the main objectiveof our current study was to understand any association with diabetes with relation to age, gender, history ofdisease, diabetic laboratory parameters, tumor size and grade. Materials and Methods: This hospital basedstudy was carried out using data retrieved from the register maintained in the Department of Biochemistryof Nepalese Army Institute of Health Sciences between 1st December, 2011 and 31st May, 2012. The variablescollected were age, gender, HbA1c, serum creatinine, fasting blood glucose. One way ANOVA was applied toexamine statistical significance of differences between groups. The LSD post hoc test was used for the comparisonof means of case groups. Results: Of the total 140 cases of renal cell carcinoma, 79 patients were also sufferingfrom diabetes mellitus. The number of females (47) was more in diabetic RCC patients when compared to males(32). Significance was observed in levels of serum creatinine for tumor size >10cm (0.0001*). The highest valueof glycated hemoglobin (8.9%) and fasting blood sugar(148.3mg/dl)in cases of renal cell carcinoma along withdiabetes mellitus was found in tumour size of 1-5cm. Conclusion: Diabetes mellitus has independent prognosticsignificance in RCC in relation to tumour size and grade