مقايسه عوارض حين عمل كوله سيستكتومي لاپاراسكوپيك در دو گروه بيماران ديابتي و غير ديابتي

A comparison between two groups of diabetic and non-diabetic patients regarding complications during laparoscopic cholecystectomy

سختي عمل كوله سيستوكتومي لاپاراسكوپيك در بيماران ديابتي به طور واضح روشن نيست و روش ارجح عمل جراحي كوله سيستكتومي در اين افراد هنوز موضوع مورد بحث است. هدف از اين مطالعه بررسي تاثير ديابت بيماران بر سختي عمل كوله سيستكتومي لاپاراسكوپيك بود. روش بررسي در اين مطالعه، اطلاعات بيماران مراجعه كننده به بيمارستان فرقاني و شهيد بهشتي قم كه از فرودين 1398 تا فروردين 1399 تحت كوله سيستكتومي لاپاراسكوپيك قرار گرفته بودند به دو گروه ديابتي و غير ديابتي تقسيم و سپس اطلاعات حين عمل شامل مدت زمان عمل، خونريزي، چسبندگي و تبديل به عمل باز از پرونده هاي مربوطه استخراج و وارد چك ليست شدند. در مرحله آخر فاكتور ديابت به عنوان يك ريسك فاكتور در اين دو گروه ﻣﻘﺎﯾﺴﻪ ﺷﺪ. ﯾﺎﻓﺘﻪ ﻫﺎ: اﺳﮑﺎر ﺷﮑﻤﯽ، ﮐﯿﺴﻪ ﺻﻔﺮا ﻗﺎﺑﻞ ﻟﻤﺲ و ﻧﮓ ﺻﻔﺮا در دو ﮔﺮوه ﺗﻔﺎوت ﻣﻌﻨﺎداري ﻧﺪاﺷﺖ )0/33=P(. اﻣـﺎ ﺳـﺎﺑﻘﻪ ﺣﻤﻼت ﮐﻮﻟﻪﺳﯿﺴﺘﮑﺘﻮﻣﯽ در دو ﮔﺮوه ﺗﻔﺎوت ﻣﻌﻨﺎداري داﺷﺖ )P<0/05(. ﻣﻘـﺎدﯾﺮ آزﻣﺎﯾﺸـﮕﺎﻫﯽ ﺑـﯿﻦ دو ﮔـﺮوه ﺗﻔـﺎوت آﻣﺎري ﻣﻌﻨﺎداري ﻧﺪاﺷﺖ )P<0/05(. ﻋﻤﻞﻫﺎي ﺳﺨﺖ در ﺑﯿﻤﺎران دﯾﺎﺑﺘﯽ ﺑﻪ ﻧﺴﺒﺖ ﺑﯿﻤﺎران ﻏﯿﺮ دﯾﺎﺑﺘﯽ ﺑﯿﺸﺘﺮ ﺑـﻮد و ﺣﺘـﯽ دو ﻣﻮرد ﺗﺒﺪﯾﻞ ﺑﻪ ﻋﻤﻞ ﺑﺎز در ﮔﺮوه ﺑﯿﻤﺎران دﯾﺎﺑﺘﯽ دﯾﺪه ﺷﺪ، اﻣﺎ ﺗﻔﺎوت آﻣﺎري ﻣﻌﻨﺎداري ﺑـﯿﻦ دو ﮔـﺮوه از ﻧﻈـﺮ ﺳـﺨﺘﯽ ﻋﻤﻞ ﻣﺸﺎﻫﺪه ﻧﺸﺪ )0/09=P(. ﺧﻮﻧﺮﯾﺰي ﺣﯿﻦ ﻋﻤﻞ، در ﺑﯿﻦ دو ﮔﺮوه ﺗﻔـﺎوت آﻣـﺎري ﻣﻌﻨـﺎداري داﺷـﺖ )0/02=P(. اﻣـﺎ ﭼﺴﺒﻨﺪﮔﯽ ﺣﯿﻦ ﻋﻤﻞ ﺑﯿﻦ دو ﮔﺮوه ﺗﻔﺎوت آﻣﺎري ﻣﻌﻨﺎداري ﻧﺪاﺷﺖ )0/38=P(. نتيجه گيري در نهايت مطالعه ما نشان داد كه ديابت مي تواند به عنوان يك ريسك فاكتور براي سختي عمل كوله سيستكتومي قابل پيش بيني باشد.

Cholecystectomy is one of the most common abdominal surgeries and its preferred method is laparoscopy. The difficulty of laparoscopic cholecystectomy in diabetic patients is not clear and the preferred method of cholecystectomy in these patients is still under controversy. Therefore, this study was performed to evaluate the difficulty of laparoscopic cholecystectomy in diabetic and non-diabetic patients. Methods This retrospective analytical study was performed in Shahid Beheshti Hospital and Forghani Educational and Medical Center from April 2019 to April 2020. Samples were easily selected and 86 people in two groups of diabetic and non-diabetic patients were included in the study. All patient records were reviewed based on inclusion and exclusion criteria for factors such as age, sex, diet, duration of surgery, bleeding, adhesions, and open surgery, and finally, diabetes as a risk factor. It was compared between the two groups. Data were analyzed in SPSS software version 22, an independent t-test was used to analyze quantitative data and the chi-square test was used to analyze qualitative data. In this study, a significance level of less than 0.05 was considered. Results Abdominal scar, palpable gallbladder and gallstone were not significantly different between the two groups (P=0.33). But the history of cholecystectomy attacks was significantly different between the two groups (P<0.05). Laboratory values were not significant (P>0.05) . Hard operations in diabetic patients were more than nondiabetic patients and even two cases of open surgery were seen in the group of diabetic patients, but there was no significant relationship (P=0.09). Intraoperative bleeding was statistically significant between the two groups (P=0.02), But adhesion during the operation was not related (P=0.38). Conclusion Finally, our study showed that diabetes can be a predictive risk factor for the difficulty of cholecystectomy.