腹腔镜胆总管探查、一期缝合和T管引流后胆道压力变化的比较  

Comparison of pressure changes in the common bile duct after laparoscopic common bile duct exploration with primary closure of bile duct or Ttube biliary drainage

作　　者：索运生[1] 张明哲[1] 尹思能[1] 肖宏[1] 陈先林[1] 易斌[1] 李涛[1] 

机构地区：[1]四川省成都市第二人民医院肝胆胰外科,成都610017

出　　处：《中国微创外科杂志》2006年第1期21-23,共3页Chinese Journal of Minimally Invasive Surgery

摘　　要：目的比较分析腹腔镜胆总管探查、取石后一期缝合胆总管和T管引流后胆道压力的变化，为腹腔镜胆总管探查、一期缝合的可行性提供试验依据。方法比较我院2003年8月-2004年1月30例腹腔镜胆总管探查、取石后胆道压力的变化，其中一期缝合15例，T管引流15例。结果①胆总管静水压测定值为6．0～18．5cmH2O（0．54-1．66kPa）。②胆道压力：一期缝合组术前、后比较，术后第l天胆道压力轻度增高，术后第5天明显下降（q=4．53l，P〈0．05）。T管引流组术后第5天胆总管压力较术前明显下降（q=3．440，P〈0．05）。2组术中测压无显著性差异（t=1．228，P=0．230），术后第1、3、5天比较2组均有显著差异（t=3．108，P=0．004；t=2．071，P=0．048；t=3．355，P=0．002），T管引流组胆道压力下降明显。结论腹腔镜胆总管探查、一期缝合后，胆总管压力无明显变化，说明此术式不会引起胆道压力过高而致胆漏；T管持续引流胆汁可降低胆总管压力。Objective To compare common bile duct pressure changes after laparoscopic common bile duct exploration between primary closure of the bile duct and T - tube drainage. Methods Postoperative common bile duct pressure changes were analyzed in 30 cases of laparoscoplc common bile duct exploration, including 15 cases of primary suture of the bile duct and 15 cases of T - tube biliary drainage respectively, from August 2003 to January 2004 in this hospital. Results ①The hydrostatic pressure in common bile duct was 6.0 18.5 cm H20 （0.54 - 1.66 kPa）. ②As compared with preoperative levels, the common bile duct pressure increased slightly on the first postoperative day and decreased significantly on the fifth postoperative day in primary suture cases （q = 4. 531, P 〈 0. 05 ） , and the pressure significantly decreased on the fifth postoperative day in T - tube drainage cases （q = 3. 440, P 〈 0. 05）. No statistical difference was found on intraoperative pressure measures between the two groups （ t = 1. 228, P = 0. 230） , and significantly lowered pressure measures were observed in T -tube drainage cases as compared with primary suture cases onl, 3, and5 days after surgery （t=3.108, P =0.004; t =2.071, P =0.048; t =3.355, P =0.002）. Conclusions The common bile duct pressure does not change obviously after laparoscopic common bile duct exploration with primary closure of the bile duct. T - tube drainage can decrease the bile duct pressure.

关 键 词：胆总管结石 腹腔镜 胆总管切开取石 一期缝合 

分 类 号：R657.4[医药卫生—外科学]