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中华肝脏外科手术学电子杂志

中华肝脏外科手术学电子杂志 ›› 2021, Vol. 10 ›› Issue (01) : 82 -86. doi: 10.3877/cma.j.issn.2095-3232.2021.01.018

所属专题： 文献；

临床研究

糖尿病对肝切除术患者围手术期情况的影响
蒋闯1, 廖明恒1, 曾勇1,†()   
  1. 1. 610041　成都，四川大学华西医院肝脏外科
  • 收稿日期:2020-10-18 出版日期:2021-02-10
  • 通信作者: 曾勇
  • 基金资助:
    国家重点研发计划(2018YFC1106800); 四川省科技计划项目(2019YFQ0001，2018SZ0115，2017SZ0003); 四川大学华西医院学科卓越发展1·3·5工程项目(ZYJC18008)

Effect of diabetes mellitus on perioperative conditions of patients undergoing hepatectomy

Chuang Jiang1, Mingheng Liao1, Yong Zeng1,†()   

  1. 1. Department of Liver Surgery, West China Hospital of Sichuan University, Chengdu 610041, China
  • Received:2020-10-18 Published:2021-02-10
  • Corresponding author: Yong Zeng
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蒋闯, 廖明恒, 曾勇. 糖尿病对肝切除术患者围手术期情况的影响[J]. 中华肝脏外科手术学电子杂志, 2021, 10(01): 82-86.

Chuang Jiang, Mingheng Liao, Yong Zeng. Effect of diabetes mellitus on perioperative conditions of patients undergoing hepatectomy[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2021, 10(01): 82-86.

目的

探讨糖尿病对肝切除术患者围手术期情况的影响。

方法

回顾性分析2015年1月至2020年3月在四川大学华西医院行肝切除术的4 003例患者临床资料。其中男2 557例，女1 446例；年龄22～79岁，中位年龄59岁。患者均签署知情同意书，符合医学伦理学规定。采用倾向评分匹配（PSM）的方法，按照1∶4匹配糖尿病组与非糖尿病组，分析糖尿病对肝切除术围手术期情况的影响。术前准备时间、术后住院时间比较采用t检验，并发症发生率的比较采用χ2检验或Fisher确切概率法。

结果

PSM后糖尿病组患者188例，非糖尿病组685例。糖尿病组术前准备时间、术后住院时间分别为（5.1±4.2）、（9.5±5.6）d，明显长于非糖尿病组的（4.2±2.7）、（8.4±5.0）d（t=3.77，2.59；P<0.05）。糖尿病组术后总体并发症发生率为11.7%（22/188），明显高于非糖尿病组的6.9%（47/685） （χ2=4.749，P<0.05）。

结论

有糖尿病基础的患者肝切除术围手术期并发症发生率明显升高，住院时间延长，应加强该类患者术前评估和围手术期管理。

关键词: 糖尿病, 肝切除术, 围手术期医护, 手术后并发症, 住院时间
Objective

To evaluate the effect of diabetes mellitus on the perioperative conditions of patients undergoing hepatectomy.

Methods

Clinical data of 4 003 patients who underwent hepatectomy in West China Hospital from January 2015 to March 2020 were retrospectively analyzed. Among them, 2 557 patients were male and 1 446 female, aged from 22 to 79 years with a median age of 59 years. The informed consents of all patients were obtained and the local ethical committee approval was received. With the propensity score matching (PSM) method, all patients were allocated into the diabetes mellitus and non-diabetes mellitus groups with a ratio of 1:4. The effect of diabetes mellitus on perioperative conditions after hepatectomy was evaluated. The preoperative preparation time and length of postoperative hospital stay was compared by using t test. The incidence of complications was compared by Chi-square test or Fisher's exact probability test.

Results

After PSM, 188 diabetes mellitus patients and 685 non-diabetes mellitus patients were included in this study. In the diabetes mellitus group, the preoperative preparation time and length of postoperative hospital stay were (5.1±4.2) d and (9.5±5.6) d, significantly longer than (4.2±2.7) d and (8.4±5.0) d in the non-diabetes mellitus group (t=3.77, 2.59; P<0.05). In the diabetes mellitus group, the overall incidence of postoperative complications was 11.7%(22/188), significantly higher than 6.9%(47/685)in the non-diabetes mellitus group (χ2=4.749, P<0.05).

Conclusions

In patients with diabetes mellitus, the incidence of perioperative complications is significantly increased and the length of hospital stay is prolonged. Preoperative evaluation and perioperative management should be strengthened.

Key words: Diabetes mellitus, Hepatectomy, Perioperative care, Postoperative complications, Length of hospital stay
表1 PSM前后糖尿病组与非糖尿病组肝切除患者基线特征比较
指标 PSM前（n=4 003） PSM后（n=873）
非糖尿病组（n=3 807） 糖尿病组（n=196） 统计值 P值 非糖尿病组（n=685） 糖尿病组（n=188） 统计值 P值
男性（例） 2 412 145 χ2=9.116 0.003 502 139 χ2=0.032 0.858
年龄（岁，±s） 49±13 60±9 t=-11.66 <0.001 59±10 60±9 t=-1.51 0.131
基础疾病（例）     χ2=26.070 <0.001     χ2=0.609 0.962
  良性肿瘤 645 13     48 13    
  肝细胞癌 1 963 124     443 119    
  感染性疾病 610 18     58 16    
  其他恶性肿瘤 425 29     102 28    
  肝转移性肿瘤 164 12     34 12    
切除肝段数量（例）     - 0.856     - 0.917
  1 1 237 68     207 63    
  2 985 51     179 49    
  3 729 36     138 36    
  4 714 37     143 36    
  5 133 4     18 4    
  6 9 0     0 0    
肝硬化（例）     χ2=1.965 0.161     χ2=0.132 0.716
  否 2 422 115     387 109    
  是 1 385 81     298 79    
表2 糖尿病组与非糖尿病组肝切除患者围手术期情况比较
组别 例数 术前准备时间（d，±s） 术后住院时间（d，±s） 总住院时间（d，±s） 并发症（例）
Ⅱ级 Ⅲ级及以上
糖尿病组 188 5.1±4.2 9.5±5.6 14.6±7.5 16 6
非糖尿病组 685 4.2±2.7 8.4±5.0 12.6±5.8 36 11
统计值   t=3.77 t=2.59 t=4.03 χ2=4.749
P值   <0.001 0.010 <0.001 0.020
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