糖尿病骨折患者围手术期的处理

目的　探讨糖尿病 (DM)骨折患者围手术期治疗的特点及DM对骨折手术的影响。方法　回顾分析 97例接受手术治疗的DM骨折患者围手术期血糖调控以及并存疾病的术前诊治情况。对术前准备时间、住院时间、伤口愈合等级、术后并发症发生率及住院费用等与非糖尿病对照组进行对比分析。　结果　 (1)DM骨折组入院后应用胰岛素将血糖控制在目标值 (空腹血糖 :6 0～ 8 0mmol/L ,餐后血糖 :8 0～ 11 1mmol/L) ,手术后期 (PP)胰岛素用量为 (0 5± 0 2 )U·d-1·kg-1,较稳定期[SP :(0 7± 0 2 )U·d-1·kg-1]和手术期 [OP :(0 7± 0 3)U·d-1·kg-1]明显减少 ,有显著性差异 (P <0 0 5 ) ;(2 )DM骨折组入院后新发现合并症 (心电图ST T改变、心律失常、高血压病、血脂异常、泌尿系感染 )病例数多于对照组 ,经过术前对症及改善微循环治疗 ,均耐受了相应的手术治疗 ;(3)DM骨折组比对照组术前准备时间延长 [(16 7± 4 2 )d比 (8 5± 3 7)d]、住院时间延长 [(30 1± 8 6 )d比 (17 6± 5 7)d],西药费、检查费、化验费均增高 ,有显著性差异 (P <0 0 1) ;(4 )手术切口全部甲级愈合 ,DM组与对照组骨折术后并发症发生率分别为 2 0 6 %和 1 0 3% ,无显著性差异 (P >0 0 5 )。结论　有效地控制DM骨折患者血糖 ,合理治     

180例胃转流手术治疗2型糖尿病术后并发症防治体会

目的总结胃转流手术治疗2型糖尿病术后并发症,探讨其防治方法。方法对2012年5月至2014年5月180例接受胃转流手术的2型糖尿病患者术后并发症进行回顾性分析。结果本组患者术后近期并发症总发生率为16.11%(29/180),其中术后胃瘫综合征发生率最高为7.78%(14/180);其次是术后胃出血2.78%(5/180);术后急性左心衰竭2.22%(4/180);术后全身瘙痒2.22%(4/180);术后烟雾病0.55%(1/180);术后切口液化0.55%(1/180)。结论术后胃瘫综合征是胃转流手术后最常见的并发症,其次是术后胃出血,以上并发症如术前采取预防措施、术后采用积极治疗手段均可避免和治愈。     

The pulmonary resection for tuberculosis in patients with severe diabetes mellitus

Peculiarities of preoperative preparation and of pulmonary resection performance, postoperative period management in 82 patients with pulmonary tuberculosis and severe diabetes mellitus were analyzed. In 29.27% of patients the complications occurred. After the operation 4.87% of patients died. Positive clinical effect was noted in 95.13% of patients, 86.04% of patients were recovered during 1-20 yrs period of follow-up. The diabetes mellitus course severity had reduced. In further follow-up period the pulmonary tuberculosis reactivation in 9.3% was noted.     

The surgical treatment of fibrous-cavernous pulmonary tuberculosis in patients with diabetes mellitus

The results of treatment of fibrocavernous tuberculosis in 75 patients with diabetes mellitus were analyzed. In 21 (28%) patients postoperative complications occurred. After the operation 4 (5.33%) patients died. In 94.67% of patients clinical efficacy was achieved. While 1 to 15-year period of observation a full clinical effect was noted in 83.8% of 37 examined patients and the tuberculosis reactivation was revealed in 10.8%.     

Application of carbon-containing materials in surgery

The authors used carbon tissue napkins manufactured from the cloth "Urals" with a selvedge which was processed according to an original method for the treatment of festered wounds. It provided quicker cleansing and healing of the wounds in comparison with conventional methods of local treatment. Cloth material on the base of carbon was used also as an implant for the treatment of abdominal wall hernias (predominantly ventral hernias). 21 operations of herniotomy were performed in 20 patients with recurrent, large, gigantic, of medium sizes hernias. In majority of patients the presence of various associated diseases (diabetes mellitus, obesity of II-IV stage, cardiovascular diseases) were revealed. There were no complications in postoperative period. All the patients were followed-up after the operation for 1 month-3 years. There were no recurrences of hernias.     

163例高龄结直肠癌合并糖尿病患者的围手术处理体会

目的 探讨高龄结直肠癌合并糖尿病患者的围手术处理。方法 对1994-2004年围手术处理的163例高龄（年龄大于印岁）结直肠癌合并糖尿病患者作回顾性分析。结果 163例病人均作结直肠癌择期手术,术后并发症发生率39．9％,其中切口感染19．6％（32／163）,肺部感染12．3％（20／163）,吻合口漏占3．7％（6／163）,泌尿系感染为2．5％（4／163）,高渗性昏迷1．2％（2／163）,死亡0．6％（1／163）。术后平均住院20天。结论 如能做到控制血糖、选择合理的术式和手术时机,高龄结直肠癌并糖尿病患者可顺利度过围手术期,并取得良好的手术疗效。     

Clinical aspects of allotransplantation of the pancreatic islet cells in patients with diabetes mellitus and acute and chronic cholecystitis

The results of treatment of 25 patients with acute and chronic cholecystitis accompanied by diabetes mellitus, who underwent transplantation of the pancreatic islet cells (PIC), and 40 patients with identical pathology, who underwent no PIC transplantation, are presented. In chronic cholecystitis and diabetes mellitus with the aim of preparation for the operation, PIC were administered intramuscularly, in acute cholecystitis and diabetes mellitus intraportally, after cholecystectomy. Transplantation of the PIC cultures in patients with diabetes mellitus contributes to correction of the impaired metabolic processes, reduction of the incidence of postoperative complications.     

胰、十二指肠及肾一期联合移植并发症的处理

目的 探讨胰肾一期联合移植术后并发症的处理经验。方法 回顾性分析５例胰、十二指肠及肾一期联合移植术后发生并发症的原因及治疗。结果 ５例术后分别存活５年１个月、４年、２２ｄ、７０ｄ和５个月,前２例目前仍健在,生活质量佳。５例均发生了近期或远期的非技术性并发症,其中包括胰瘘、胰周感染及脓肿、十二指肠残端瘘、膀胱炎、血尿、排斥反应、巨细胞病毒感染、代谢性酸中毒、尿潴留与尿道狭窄等。结论 胰、肾一期联合移     

糖尿病患者行腹腔镜及开腹胆囊切除术81例报告

目的探讨外科治疗胆囊结石合并糖尿病的手术方式和时机的选择。方法回顾分析手术治疗胆囊结石合并糖尿病81例临床资料,其中腹腔镜胆囊切除术（LC）组41例,开腹胆囊切除术（OC）组40例。比较两组手术时间、术中出血量、住院时间、并发症发生率及围手术期血糖变化。结果LC与OC组相比,术中出血量少、手术时间短、术后住院时间少,两组比较差异有统计学意义。LC组总并发症发生率明显低于开腹组（P〈0．05）,其中切口并发症发生率低于OC组（P〈0．05）。LC组术中血糖明显低于OC组,但术前和术后血糖的变化,差异无统计学意义。结论腹腔镜胆囊切除术具有创伤小、恢复快、并发症少等优点,用于治疗胆囊结石合并糖尿病可行,且安全有效。急性结石性胆囊炎合并糖尿病患者应尽量早期手术治疗。     

Treatment of an acute cholecystitis in elderly and senile patients with diabetes mellitus]

Results of surgical treatment of an acute cholecystitis (ACH) in 114 elderly and senile patients with diabetes mellitus were analyzed. In all operated patients histological investigation revealed destructive forms of an ACH, mainly complicated. After the operation in 14 (12.3%) of patients complications occurred. Tactics of treatment was based mainly on securing of adequate correction of carbohydrate metabolism before, during and after performance of operation and also on early performance of cholecystectomy using laparoscopic method, permitting to reduce frequency of postoperative complications occurrence and to lower postoperative lethality.     

胰、肾联合移植六例报告

目的 探讨胰、肾联合移植治疗糖病合并糖尿病肾病的疗效。方法 回顾分析近期施行的6例胰、肾联合移植手术的方法、疗效及并发症的防治。结果 6例患者分别于移植胰腺恢复血液循环后23h、第9d、17h、19h、第5d及1．5h停用外源性胰岛素,移植肾功能于术后第2－4d恢复正常;术后并发症有排斥反应和血尿,其中1例术后5d发生加速性排斥反应,抗排斥治疗无效,于术后11d切除移植胰、肾,其余5例均痊愈出院。结论 胰、肾联合移植是治疗胰岛素依赖型糖尿病及达到胰岛素依赖期的非胰岛素依赖型糖尿病合并糖尿病合并糖尿病肾病的有效方法;加强围手术期管理术后减少各种并发症、取得良好疗效的有效措施。     

高龄大肠癌合并糖尿病19例外科治疗体会

目的　探讨高龄大肠癌合并糖尿病的外科治疗措施。方法　对我院 1 993年 1月～2 0 0 1年 1 2月外科治疗的 1 9例高龄大肠癌合并糖尿病病人作回顾性的分析。结果　 1 9例均行择期手术。术后并发症发生率 :肺部感染 2 1 % ,心律失常 1 0 .5 % ,泌尿系统感染 1 5 .6 % ,切口感染 1 0 .5 %。无吻合口瘘和酮症酸中毒发生。术后平均住院时间 2 5d ,无死亡病例。结论　对高龄大肠癌合并糖尿病者只要围手术期严格控制血糖 ,选择合理术式 ,完全可以达到理想的外科治疗效果     

胰、肾一期联合移植五例报告

目的 总结胰、肾联合移植的临床经验。方法 为5例糖尿病合并糖尿病肾病、肾功能衰竭患者施行胰、肾联合移植术，对手术技术、术后排斥反应的防治和其它非手术并发症的处理进行总结。结果 5例患者肾功能均转为正常，其中2例分别于术后第8周和第23周各发生急性排斥反应1次，经抗排斥治疗后肾功能逆转；2例手术后2周发生纯红细胞再生障碍性贫血；1例手术后第33d因供胰动脉血栓形成切除胰腺。经1年以上观察，5例患者均健康存活，其中4例胰、肾功能良好。结论 胰、肾联合移植是目前治疗糖尿病合并糖尿病肾病的有效手段；手术操作轻柔精细及术后并发症的预防对受者存活、移植物功能的恢复有重要意义。     

Insulin Dependence Increases the Risk of 30-Day Postoperative Complications Following Ankle Fracture Surgery in Patients With Diabetes Mellitus

Patients with diabetes mellitus that undergo ankle fracture surgery have higher rates of postoperative complications compared to patients without diabetes mellitus. We evaluated the rate of complications in insulin-dependent diabetes mellitus patients, non–insulin-dependent diabetes mellitus patients, and patients without diabetes in the 30-day postoperative period following ankle fracture surgery. We also analyzed hospital length of stay, unplanned readmission, unplanned reoperation, and death. Patients who underwent operative management for ankle fractures between 2012 and 2016 were identified in the American College of Surgeons National Surgical Quality Improvement Program® database using Current Procedural Terminology codes. Multiple logistic regression was implemented. Adjusted odds ratios were calculated along with the 95% confidence interval. A total of 19,547 patients undergoing ankle surgery were identified from 2012 to 2016. Of these patients, 989 (5.06%) had insulin-dependent diabetes mellitus, 1256 (6.43%) had noninsulin-dependent diabetes mellitus, and 17,302 (88.51%) did not have diabetes mellitus. Compared to patients without diabetes, patients with insulin-dependent diabetes mellitus had significantly greater adjusted odds of superficial surgical site infections, deep surgical site infections, osteomyelitis, wound dehiscence, pneumonia, unplanned intubation, mechanical ventilation, urinary tract infection, cardiac arrest, bleeding requiring transfusion, sepsis, hospital length of stay, unplanned readmission, unplanned reoperation, and death following ankle fracture surgery. We demonstrate that insulin-dependent diabetes mellitus is a strong predictor of 30-day postoperative complications, unplanned readmission, unplanned reoperation, and death following ankle fracture surgery.     

糖尿病对胆道手术的影响及治疗对策

目的探讨糖尿病对胆道手术的影响及控制血糖的有效方法。方法通过设立严格的病例对照，比较40例糖尿病患者与非糖尿病患者、胰岛素强化治疗与非强化治疗胆道术后并发症的发生率。结果糖尿病显著增加胆道术后并发症的发生率，围手术期胰岛素强化治疗，可减少并发症的发生。结论高血糖是胆道病患者术后并发症高发生率的主要原因，严密监测血糖、尿糖，规范围手术期胰岛素强化治疗是预防术后并发症的关键。     

Carbohydrate metabolism after pancreatoduodenal resections in patients with chronic pancreatitis

The carbohydrate metabolism was analyzed in 70 patients with the complicated chronic pancreatitis before and after pylorus-preserving pancreatoduodenal resection (PPDR). Patients were aged 42±1,15 years, of them 64 were men and 6 - women. Bodymass index was 2,2±0,54kg/m2. Patients were divided in groups according to pre- and postoperative glucose metabolism disorders to define the diabetes morbidity by chronic pancreatitis and the influence of surgery on the first. According to the preoperative data, diabetes mellitus of mild severity had 9 of 70 operated patients, 18 patients had medium diabetes. After the operation only one patient demonstrated the aggravation of diabetes. However, the onset of diabetes mellitus was registered in 8 patients postoperatively. The increased glucose blood level in early postoperative period proved to have a high prognostic significance. Therefore, all patients of that category must be strongly recommended to be under the endocrinologist's observation after hospital discharge. That measure would provide a timely diagnose and treatment of the diabetes mellitus. All patients with chronic pancreatitis should be thoroughly investigated concerning glucose metabolism disorders before the operation.     

Surgical treatment of tuberculosis and nonspecific lung diseases associated with diabetes mellitus

The results of treatment of 103 patients with tuberculosis and non-specific diseases of the lungs with concomitant diabetes mellitus were analysed. The main principles of preoperative preparation and postoperative management of the patients are presented. The incidence of operative complications was 10.7%, postoperative--17.5%, mortality--2.9%. The clinical effect was achieved in 97.1% of patients. Reactivation of tuberculosis after operation was noted in 7.8% of patients.     

老年患者择期开腹手术后感染风险因素分析

目的探讨老年患者择期开腹手术后发生感染并发症的危险因素。方法对2010年5月至2012年2月期间笔者所在医院收治的159例接受择期开腹手术的老年患者的临床资料进行回顾性分析。其中38例（23.90％）术后出现感染并发症（感染组）,121例无感染并发症（无感染组）,比较2组患者术前相关生理学指标、健康状况指标、手术指标以及术后感染并发症及死亡情况的差异。结果本组159例患者术后感染并发症发生率为23.90％（38／159）;术后死亡2例,术后病死率为1.26％。单因素及多因素logistic回归分析结果提示,患者术前的营养风险、糖尿病史和慢性呼吸系统疾病是术后感染并发症的独立危险因素。结论术前改善老年患者肺部疾病、糖尿病及营养状态,可能对降低术后感染并发症发生率有益。     

Ponderal index as a predictor of postoperative complications

Four hundred sixty-eight patients undergoing elective surgery were prospectively followed for the development of postoperative complications. There was a trend toward increasing complication rate with a lower ponderal index. However, lower ponderal indices were associated with increasing rates of diabetes mellitus and hypertension. Of these patients, forty cases with postoperative complications were matched to 40 control cases for sex, age, concomitant illness and operation performed. The cases of postoperative complications had a statistically significantly lower ponderal index than the controls (11.98 versus 12.43). The increased risk of postoperative complications in those patients with a ponderal index of less than 11 was 3.36, and less than 13 was 3.44. Surgeons who treated patients with lower ponderal indices need to have a high index of suspicion for the development of postoperative complications in these patients.     

老年人脊柱结核的外科治疗

目的探讨老年人脊柱结核外科治疗的围手术期处理方法和手术疗效。方法回顾分析1998年5月至2005年6月行手术治疗的36例老年人脊柱结核患者的临床资料。年龄61～86岁,平均70．2岁。术前有合并症者28例,合并截瘫者20例。3例行CT引导下经皮穿刺置管引流术;12例行前路病灶清除、植骨、前路内固定术;5例选择前路清除病灶、植骨、后路内固定术;7例采用经肋横突病灶清除、椎间植骨,后路椎弓根系统内固定术;9例行后路病灶清除、植骨和内固定术。术后抗结核药物治疗9—24个月。随访时间1．5—6年,平均3年10个月。结果术后33例次发生并发症,1例术后围手术期肺部感染死亡,随访期间因心梗及脑出血各死亡1例,其余患者病灶治愈,未再复发。31例患者X线片显示植骨融合。后凸畸形得到部分矫正。术前截瘫者,完全恢复11例,部分恢复5例。结论通过对伴发疾病及并发症的患者术前认真评估和处理,老年脊柱结核患者一般可耐受手术治疗。手术治疗及内固定的应用有助于病灶愈合,促进恢复。