围手术期血糖水平对2型糖尿病患者机器人辅助腹腔镜根治性前列腺切除术后切口愈合不良的影响及危险因素分析OA
Impact of perioperative glycemia on poor wound healing after robot-assisted laparoscopic radical prostatectomy in patients with type 2 diabetes mellitus and its risk factors
目的:探讨围手术期血糖水平对合并 2 型糖尿病的前列腺癌患者行机器人辅助腹腔镜根治性前列腺切除术(RARP)后切口愈合不良的影响及其危险因素.方法:回顾性分析 2023 年 1 月—2024 年 12 月在连云港市第一人民医院行 RARP 的90 例合并 2 型糖尿病的前列腺癌患者的临床资料.根据术后 30 d 内是否发生切口愈合不良,将患者分为愈合不良组(n=18)与正常愈合组(n=72).比较两组患者的一般资料、切口愈合情况及术后住院时间,采用单因素分析和多因素 Logistic 回归分析筛选术后切口愈合不良的独立危险因素.同时,根据患者术前空腹血糖(FBG)水平及术后第 1 天血糖水平,将其分为血糖控制良好组、术后高血糖组、术前高血糖组和持续高血糖组,进一步分析围手术期血糖水平对切口愈合的影响.结 果:90 例患者中,18 例发生术后切口愈合不良,其中切口红肿渗液 12 例,切口感染4 例,切口裂开 2 例.愈合不良组术前 FBG 及糖化血红蛋白(HbA1c)水平均显著高于正常愈合组,术后住院时间显著长于正常愈合组,差异均有统计学意义(P<0.05).单因素分析显示,术前FBG≥10 mmol/L、HbA1c≥8.5%、BMI≥28 kg/m2、手术时间≥180 min 与术后切口愈合不良相关(P<0.05).多因素 Logistic 回归分析显示,术前 FBG≥10 mmol/L 和HbA1c≥8.5%是术后切口愈合不良的独立危险因素.进一步分析围手术期血糖水平对切口愈合的影响,结果显示持续高血糖组的切口愈合不良发生率最高,组间差异具有统计学意义(P<0.05).结论:术前 FBG≥10 mmol/L 和 HbA1c≥8.5%是合并 2 型糖尿病的前列腺癌患者行 RARP后发生切口愈合不良的独立危险因素.术前应加强血糖管理,重视术后血糖监测与控制,建议将FBG控制在10 mmol/L以下,以降低术后切口并发症发生风险.
Objective:To investigate the impact of perioperative blood glucose levels on poor wound healing after robot-assisted laparoscopic radical prostatectomy(RARP)in prostate cancer patients complicated with type 2 diabetes mellitus(T2DM)and to analyze its risk factors.Methods:Clinical data of 90 prostate cancer patients complicated with T2DM who underwent RARP at Lianyungang First People's Hospital from January 2023 to December 2024 were retrospectively analyzed.Patients were divided into the poor wound healing group(n=18)and the normal wound healing group(n=72)according to whether poor wound healing occurred within 30 days postoperatively.Clinical data,wound healing status,and postoperative length of hospital stay were compared between the two groups.Univariate analysis and multivariate logistic regression analysis were used to identify independent risk factors for poor postoperative wound healing.Additionally,patients were divided into four groups based on preoperative fasting blood glucose(FBG)and blood glucose levels at postoperative day 1,including well-controlled blood glucose group,postoperative hyperglycemia group,preoperative hyperglycemia group and persistent hyperglycemia group to further analyze the impact of perioperative blood glucose levels on wound healing.Results:Among the 90 patients,18 developed poor wound healing,including 12 cases of wound redness,swelling and exudation,4 cases of wound infection,and 2 cases of wound dehiscence.The poor wound healing group had significantly higher preoperative FBG and glycated hemoglobin(HbA1c)levels and significantly longer postoperative length of hospital stay than the normal wound healing group(P<0.05).Univariate analysis showed that preoperative FBG≥10 mmol/L,HbA1c≥8.5%,BMI≥28 kg/m2,and operative time≥180 minutes were associated with poor postoperative wound healing(P<0.05).Multivariate logistic regression analysis indicated that preoperative FBG≥10 mmol/L and HbA1c≥8.5%were independent risk factors for poor postoperative wound healing.Further analysis of perioperative blood glucose levels on wound healing showed that the persistent hyperglycemia group had the highest incidence of poor wound healing,with statistically significant differences among groups(P<0.05).Conclusion:Preoperative FBG≥10 mmol/L and HbA1c≥8.5%are independent risk factors for poor wound healing after RARP in patients with T2DM.Enhanced preoperative blood glucose management and postoperative blood glucose monitoring and control are recommended.FBG should be controlled below 10 mmol/L to reduce the risk of postoperative wound complications.
陈兆旭;代佳欣;吉振帅;谢程;张坤;蔡成宽
南京医科大学连云港临床医学院·连云港市第一人民医院泌尿外科 江苏 连云港 222000南京医科大学连云港临床医学院·连云港市第一人民医院泌尿外科 江苏 连云港 222000南京医科大学连云港临床医学院·连云港市第一人民医院泌尿外科 江苏 连云港 222000南京医科大学连云港临床医学院·连云港市第一人民医院泌尿外科 江苏 连云港 222000南京医科大学连云港临床医学院·连云港市第一人民医院泌尿外科 江苏 连云港 222000南京医科大学连云港临床医学院·连云港市第一人民医院泌尿外科 江苏 连云港 222000
医药卫生
前列腺癌机器人辅助腹腔镜手术糖尿病空腹血糖切口愈合不良
Prostate CancerRobot-assisted Laparoscopic SurgeryDiabetes MellitusFasting Blood GlucosePoor Wound Healing
《机器人外科学杂志（中英文）》 2026 (5)
771-776,6
江苏省中医药科研项目(YB2020074)Jiangsu Provincial Scientific Research Project on Traditional Chinese Medicine(YB2020074)
评论