标题：不同方法治疗单纯性阑尾炎合并糖尿病疗效比较

      作者：林木本 1，孙相钊 2，刘永源 3，陈宗梅 2
    (1.廉江市人民医院普通外科，广东 廉江 524400；
2.廉江市人民医院消化内科，广东 廉江 524400；
3.广东医科大学附属医院普通外科，广东 湛江 524001)

      卷次： 2016年27卷19期

      【摘要】 目的 探讨抗生素保守治疗(CT)、内镜逆行阑尾炎治疗术(ERAT)和腹腔镜阑尾切除术(LA)在单纯性
阑尾炎(SA)合并糖尿病(DM)患者中的应用效果。方法 根据患者的意愿和实际情况，将2012年10月至2015年10
月期间在廉江人民医院求治的125例SA合并DM患者分为A组(36例)、B组(44例)和C组(45例)。A组、B组和C组
分别行抗生素CT、ERAT和LA治疗。检测三组患者的机体免疫功能和胰腺分泌功能，并比较其治疗效果和不良事
件。结果 A、B、C三组患者的“治疗12 h腹痛VAS分数<3分”构成比分别为61.11%、86.36%和93.33%，其中A组
的构成比明显低于其他两组，差异均有统计学意义(P<0.012 5)；A、B、C三组患者的“治疗24 h白细胞恢复正常”构
成比分别为58.33%、63.64%和86.67%，其中 C组的构成比明显高于其他两组，差异均有统计学意义(P<0.012 5)；A、
B、C三组患者的半年阑尾炎复发率分别为22.22%、15.91%和0，其中A、B组的复发率均明显高于C组，差异均有统
计学意义(P<0.012 5)；A、B、C三组患者治疗24 h后的C反应蛋白浓度分别为(14.98±3.17) mg/L、(16.56±3.28) mg/L
和(35.24±3.55) mg/L，其中以C组最高，B组次之，差异均有统计学意义(P<0.05)。在手术结束后30 min或第1次使
用抗生素结束后 30 min时，三组患者的血清C肽、胰岛素和血糖比较差异均无统计学意义(P>0.05)。结论 抗生
素CT、ERAT和LA治疗SA合并DM均有疗效，但抗生素CT和ERAT方案的复发率高，LA仍然是SA合并DM的首
选方案。

      【关键词】 阑尾炎；糖尿病；保守治疗；内镜逆行阑尾炎治疗术；腹腔镜阑尾切除术；疗效

      【中图分类号】 R656.8 【文献标识码】 A 【文章编号】 1003—6350（2016）19—3157—04


Comparison on the therapeutic effect of different treatments for simple appendicitis complicated with diabetes
mellitus.
LIN Mu-ben 1, SUN Xiang-zhao 2, LIU Yong-yuan 3, CHEN Zong-mei 2. 1. Department of General Surgery, the
People's Hospital of Lianjiang, Lianjiang 524400, Guangdong, CHINA; 2. Department of Gastroenterology, the People's
Hospital of Lianjiang, Lianjiang 524400, Guangdong, CHINA; 3. Department of General Surgery, the Affiliated Hospital of
Guangdong Medical University, Zhanjiang 524001, Guangdong, CHINA

【Abstract】 Objective To investigate the application effect of conservative treatment (CT) with antibiotics, en-
doscopic retrograde appendicitis therapy (ERAT) and laparoscopic appendectomy (LA) in patients with simple appendici-
tis (SA) complicated with diabetes mellitus (DM). Methods A total of 125 patients with SA complicated with DM treat-
ed in People's Hospital of Lianjiang from October 2012 and October 2015 were divided into group A (36 cases), group B
(44 cases) and group C (45 cases) according to the patient's wishes and practical situation. Group A, group B and group
C were treated with CT, ERAT and LA, respectively. Immune function and pancreatic secretion function were detected,
and the therapeutic effect and adverse events were compared between the three groups. Results The constituent ratios
of abdominal pain VAS scores<3 at post-treatment 12 hours in group A, B and C were 61.11%, 86.36% and 93.33%, and
the constituent ratio of group A were significantly lower than that in the group B and group C (P<0.012 5). The constitu-
ent ratio of white blood cells returned to normal at post-treatment 24 hours in group A, B and C were 58.33%, 63.64%
and 86.67%, and the constituent ratio of group C were significantly higher than that in the group A and group B (P<
0.012 5). The recurrence rate of group A, B and C were 22.22%, 15.91% and 0, and the recurrence rate of group A and
group B were significantly higher than that in the group C (P<0.012 5). The C-reactive protein concentration were
(14.98±3.17) mg/L, (16.56±3.28) mg/L and (35.24±3.55) at post-treatment 24 hours in the 3 groups, and concentration of
group C was the highest, followed by group B, with statistically significant difference between the three groups (P<
0.05). Serum C peptide, insulin and blood glucose were not different between the 3 groups at 30 minutes after the opera-
tion and first use of antibiotics after the end of 30 min (P>0.05). Conclusion The therapeutic effect of CT with antibiot-
ics, ERAT and LA in the SA complicated with DM is very significant, but the recurrence rates of antibiotics CT and ER-
AT are high. Therefore, LA remains the preferred option for SA complicated with DM.

      【Key words】 Appendicitis; Diabetes mellitus; Conservative treatment; Endoscopic retrograde appendicitis thera-
py; Laparoscopic appendectomy; Therapeutic effect
·论 著·doi:10.3969/j.issn.1003-6350.2016.19.021