摘要
Abstract
Objective To investigate the change of gallbladder contractive function and the recurrence rate of gallstone after the therapy of laparoscope combined with choledochoscopic microinvasive gallbladder - protected lithotomy on T2DM patients combined with gallstone having good blood glucose control. Methods From June 2009 to June 2012,we enrolled 60 T2DM patients combined with gallstone as experimental group and enrolled 60 gallstone patients without DM as control group from the Second Affiliated Hospital of Hebei North Medical University. Patients of experimental group all used normal insulin to control blood glucose. Perioperative fasting blood glucose was controlled ≤ 7. 2 mmol/ L,and 2 h postprandial blood glucose was controlled ≤ 9. 0 mmol/ L. Patients of both groups underwent laparoscope combined with choledochoscopic microinvasive gallbladder - protected lithotomy. Before surgery and 3,12 and 24 months after surgery,Lundh meal ultrasound examination was conducted to examine the maximum contractive rate of gallbladder,and 3,12 and 24 months after surgery,gallbladder B ultrasound examination was conducted to examine the recurrence of gallstone. Results All patients recovered smoothly without surgical incision infection,infection of biliary tract,bile leak,bile duct injury or death in perioperative period;no acute cholecystitis,cholangitis,intra - and extrahepatic bile duct stone and biliary stricture occurred;biliary colic attacks occurred at night in 2 patients with recurrent gallstone and lasted for 2 hours at most,and the two patients relieved gradually without special treatment after body position change. During the 24 - month following - up period,6 cases dropped out of the experiment,of which were 2 cases in control group and 4 cases in experiment group. There was no interactions between the maximum shrinkage rate of gallbladder treatment and time of patients in two groups(Finteraction = 0. 469,Pinteraction = 0. 707),there was no significant effects between groups(Fgroup = 0. 850,Pgroup = 0. 365),there was significant effects among different time(Ftime = 8. 880,Ptime= 0. 001). The two groups were not significantly different in the maximum gallbladder contractive rate before surgery,and 3,12 and 24 months after surgery(P ﹥ 0. 05). Control group and experimental group had lower maximum gallbladder contractive rate 3 months after surgery than that before surgery( P ﹤ 0. 05 );control group and experimental group had higher maximum gallbladder contractive rate 12 and 24 months after surgery than that 3 months after surgery( P ﹤ 0. 05). No recurrence of gallstone was found in both groups 3 months after surgery;12 months after surgery,there was 1(1. 7% ,1 / 58)patient in control group and 1(1. 8% ,1 / 56)patient in experimental group who had recurrence,and there was no significant difference between them(χ2 = 0. 001,P = 0. 980);24 months after surgery,there were 2(3. 4% ,2 / 58)patients in control group and 2(3. 6% ,2 / 56)patients in experimental group who had recurrence of gallstone,and there were no significant difference between them(χ2 = 0. 001,P = 0. 972). Conclusion Laparoscope combined with choledochoscopic microinvasive gallbladder- protected lithotomy on T2DM patients combined with gallstone having good blood glucose control can well protect and improve the gallbladder contractive function and keep good gallbladder contractive function 24 months after surgery. There is no difference between diabetic patients and non - diabetic patients in the recurrence rate of gallstone within 24 months after surgery.关键词
糖尿病,2 型/胆囊结石病/微创保胆取石/治疗结果/复发Key words
Diabetes mellitus,type 2/Cholecystolithiasis/Micro - invasive cholecystolithotomy/Treatment outcome/Recurrence分类
医药卫生
