多腔T型管在肝胆管结石再次胆道手术中的临床应用  

Clinical application of multi cavity T tube in reoperation of biliary tract operation of hepatolithiasis

作　　者：唐华勇[1] 袁通立[1] 彭婷[1] 杨毅[1] 肖群[1] 贺彦宇[1] 肖凡[2] 

机构地区：[1]湖南株洲市湖南中医药高等专科学校附属第一医院肝胆外科,株洲412000 [2]湖南株洲市湖南中医药高等专科学校

出　　处：《肝胆外科杂志》2015年第1期41-45,共5页Journal of Hepatobiliary Surgery

摘　　要：目的探讨"多腔T型管"在肝胆管结石再次胆道手术中的临床应用效果。方法回顾性总结我院肝胆外科2011年4月至2014年3月收治的80例复发性胆管结石再次胆道手术患者的临床资料,患者均签署知情同意书,符合医学伦理学规定。将80例再次胆道手术患者依据手术方式随机分成两组,治疗组(40例)和对照组(40例),均采用开腹胆道探查术,治疗组术中放置多腔T型管;对照组术中放置普通T型管。记录两组病人术后胆汁丢失量、术后补液量;采集每个病人术前及肠内营养后3 d、7 d的转铁蛋白、前白蛋白及视黄醇结合蛋白的生化参数指标;记录术后相关并发症的发生情况(包括胃肠道并发症、胆道感染、胆漏)及术后2月结石残留率情况。结果治疗组术后胆汁丢失总量(846±112 ml)、术后输液量(13.75±3.68 L),明显少于对照组的(5 470±450 ml)、(25.63±4.32 L),差异有统计学意义(t=-63.064、-13.240,P<0.05)。治疗组肠内营养后3 d前白蛋白(260±37.58 mg/L)及视黄醇结合蛋白(45.53±8.69 mg/L)均高于对照组的(193±33.12 mg/L)、(35.72±6.72 mg/L),差异有统计学意义(t=8.458、5.648,P<0.05)。并且治疗组肠内营养后7 d转铁蛋白(314±44.72 mg/ml)、前白蛋白(304±40.34 mg/L)及视黄醇结合蛋白(51.23±10.34 mg/L)均高于对照组的(203±33.62mg/ml)、(256±37.46 mg/L)、(39.53±8.49 mg/L),差异有统计学意义(t=12.548、5.514、5.531,P<0.05)。两组行肠内营养期间,治疗组胃肠道并发症发生率为5.0%,对照组为30.0%,差异有统计学意义(χ2=7.013,P<0.05)。两组行胆道冲洗期间,无一例出现胆漏,治疗组胆道感染率为2.5%(1/40),对照组胆道感染率为7.5%(3/40),两组比较差异无统计学意义(χ2=0.263,P>0.05)。治疗组结石残留率10.0(4/40),对照组结石残留率40.0%(16/40),两组比较差异有统计学意义(χ2=8.067,P<0.05)。结论在肝胆管结石再次胆道手术后,经多腔T型管行胆汁回输联合肠内营养及胆�Objective To investigate Clinical application effect of multi cavity T tube in reoperation of biliary tract operation of hepatolithiasis. Methods The subjects of this retrospective study were 80 patients with hepatolithiasis who underwent surgery in Department of hepatobiliary surgery, the First Affiliated Hospital of Hunan Traditional Chinese Medical College from April 2011 to March 2014. 80 cases of hepatofithiasis based on the mode of operation were randomly divided into two groups, the treatment group （40 cases） and control group （40 cases）. All groups adopt open common bile duct exploration, the treatment group was placed in multi cavity T type tube, the control group was placed in ordinary T type tube. Record two groups of patients postoperative total bile loss and postoperative fluid infusion; acquisition biochemical parameters of transferrin, prealbumin and retinol-binding protein in each patient before surgery and enteral nutrition after three days, seven days ; Record the occurrence of postoperative complications （ including gastrointestinal complications, biliary infection, biliary leakage） and postoperative residual stone rate in two months later. Results The postoperative total bile loss was （846 ±112 ml）, the postoperative fluid infusion was （13.75 ±3.68 L） in treatment group, significantly less than the control group of （5470±450 ml）, （25.63 ±4. 32 L）, the difference was statistically significant （t = -63. 064, - 13. 240,P 〈0. 05）. The prealbumin （260 ±37. 58 mg/L） and retinol binding protein （45.53 ±8.69 mg/L） in treatment group after three days enteral nutrition was higher than that of the control group （ 193 ±33. 12 mg/L）, （35.72 ±6. 72 mg/L）, the difference was statistically significant （ t = 8. 458,5. 648, P 〈 0. 05 ）. the transferrin （314 ±44. 72 mg/ml）, prealbumin （ 304 ±40. 34 mg/L） and retinol binding protein （51.23± 10. 34 mg/L） in treatment group after seven days enteral nutrition was higher than that of the c

关 键 词：多腔T型管 肝胆管结石 再次胆道手术 胆汁回输 肠内营养 

分 类 号：R657.4[医药卫生—外科学]