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目的探讨结直肠癌合并糖尿病患者围手术期胰岛素强化治疗的安全性及有效性。方法对58例结直肠癌合并糖尿病患者,围手术期采用“小剂量开始,个体化调整”原则。术中胰岛素、葡萄糖双通道静脉滴注;术后及伴有并发症者静脉滴注胰岛素以控制围手术期血糖。结果术后感染性并发症7例,吻合口瘘3例,低血糖1例,酮症酸中毒1例。吻合口瘘中1例直肠癌患者行横结肠造瘘术,待8个月吻合口瘘愈合后行横结肠造瘘还纳术。余患者均经对症治疗后好转,围手术期内无死亡病例。结论结直肠癌合并糖尿病患者围手术期血糖控制在一定范围,并选择合理的术式,可安全度过围手术期,并达到预期疗效。
Objective To investigate the safety and efficacy of perioperative intensive insulin therapy in patients with colorectal cancer and diabetes mellitus. Methods 58 cases of colorectal cancer with diabetes mellitus, perioperative use of “low-dose start, individual adjustment ” principle. Intraoperative insulin, glucose dual-channel intravenous infusion; postoperative complications associated with intravenous infusion of insulin to control perioperative blood sugar. Results Postoperative infectious complications in 7 cases, anastomotic leakage in 3 cases, hypoglycemia in 1 case, ketoacidosis in 1 case. Anastomotic fistula in 1 case of rectal cancer patients underwent transverse colostomy, anastomotic fistula to be 8 months after the line transverse colostomy also satisfied surgery. More than the remaining patients were symptomatic treatment improved, no perioperative deaths. Conclusion Perioperative blood glucose control in patients with colorectal cancer with diabetes mellitus is in a certain range. Choosing a reasonable surgical procedure can safely perioperatively achieve the desired therapeutic effect.