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目的观察2型糖尿病患者实施腹腔镜胆道镜联合微创保胆取石术的可行性。方法选取术前胆囊收缩功能≥30%胆囊结石患者114例,实施腹腔镜胆道镜双镜联合微创保胆取石术。其中合并2型糖尿病(DM组)56例,非糖尿病患者(n DM组)58例。术后3个月内均恢复顺利,无手术切口感染、肺部感染、胆瘘、胆道损伤及胆道狭窄等并发症发生。比较2组胆囊最大收缩率变化情况、术后胆囊结石复发率。结果 DM组术后3个月时胆囊最大收缩率为(33.5±5.1)%,低于术前的(40.7±8.3)%,差异有统计学意义(P<0.05);但在术后12个月及24个月时最大收缩率分别达到(43.4±6.3)%和(50.7±12.9)%,明显优于术前(P<0.05);且DM组最大收缩率与同期n DM组比较(P>0.05)。术后2年2组结石复发率比较差异无统计学意义(P>0.05)。结论 2型糖尿病病程短、平诉血糖控制良好的胆囊结石患者,术前胆囊收缩功能良好,微创保胆取石术后,胆囊收缩功能依然良好,术后2年结石复发率与非糖尿病患者相当。术后较远期的胆囊收缩功能变化及结石复发率有待进一步研究。
Objective To observe the feasibility of laparoscopic choledochoscopy combined with minimally invasive gallbladder surgery in patients with type 2 diabetes mellitus. Methods 114 patients with cholecystolithiasis≥30% before cholecystolithiasis were selected, and laparoscopic choledochoscopy combined with minimally invasive preservation of gallstones was performed. There were 56 cases with type 2 diabetes mellitus (DM group) and 58 cases with non-diabetic (n DM group). Within 3 months after operation, all patients recovered smoothly without complications of surgical incision infection, pulmonary infection, biliary fistula, biliary tract injury and biliary stricture. Comparing the changes of maximal contraction rate of gallbladder in two groups, the recurrence rate of gallstone after operation. Results The maximal shrinkage rate of gallbladder in DM group was (33.5 ± 5.1)% at 3 months after operation, which was lower than that of preoperative (40.7 ± 8.3)%, the difference was statistically significant (P <0.05) (43.4 ± 6.3)% and (50.7 ± 12.9)%, respectively, which were significantly better than those before operation (P <0.05). The maximum contraction rate in DM group was significantly higher than that in n DM group (P > 0.05). There was no significant difference in the recurrence rate between the two groups in 2 years after operation (P> 0.05). Conclusions Patients with type 2 diabetes who have a short duration of treatment and who control the blood sugar of the patients with type 2 diabetes mellitus have good preoperative gallbladder contractility and minimally invasive gallbladder surgery, the function of gallbladder contractility is still good. The recurrence rate of stones after 2 years is similar to that of non-diabetic patients . More distant postoperative changes in gallbladder function and stone recurrence needs further study.