腹腔镜胆囊切除术后钛夹与可吸收夹留置体内影响的比较  

Comparison of the effect of remaining titanium clips with the absorbable polymeric clips used for laparoscopic cholecystectomy

作　　者：李和坤 钟复光[2] 杨苏锦 吴新祥 孙小平 李贵忠 邓维 

机构地区：[1]贵州省贵阳市第二人民医院普外科,550005 [2]贵阳医学院病理教研室

出　　处：《中华普通外科杂志》2000年第9期544-546,共3页Chinese Journal of General Surgery

摘　　要：目的　比较钛夹与可吸收夹在腹腔镜胆囊切除术后留置体内对肝胆局部组织的影响。方法　对 6 0例行腹腔镜胆囊切除术后 3～ 6个月的患者进行随访 ,随机选择使用钛夹和可吸收夹夹闭胆囊管和胆囊动脉的各 30例 ,作B超、CT和肝功能酶学检查。 (2 )将 30只家兔分 3组 ,分别用钛夹、可吸收夹、丝线 (对照 )在开腹胆囊切除术中封闭胆囊管。在术后 2、4、6个月分别以肉眼、光镜和电镜形态学方法检查 3种留置物局部肝胆组织变化。结果　 (1)CT检查钛夹组 2 9例胆囊区见到金属夹影及干扰 ,可吸收夹组无。B超、肝功能酶学检查结果差异无显著意义 (P >0 0 5 )。 (2 )实验动物检查发现 :钛夹周围纤维增生包裹层最薄 ,可吸收夹较厚 ;钛夹包裹层外肝组织有棕褐色异常沉着物 ,肝细胞内高电子密度次级溶酶体显著增多 ,与可吸收夹比较差异有显著意义 (P <0 0 1)。结论　可吸收夹用于夹闭胆囊管残端和血管安全、可靠 ,而且对局部肝组织的刺激作用显著小于钛夹。Objective[WT5”BZ] To compare the influence of remaining titanium clips with that of the absorbable polymeric ones on the intrabdominal organ after LC.[WT5”HZ] Methods [WT5”BZ] In this study 30 LC cases with titanium clips and 30 LC cases using absorbable clips were reviewed by B-mode ultrasound, CT and liver function test respectively 3～6 months after LC 30 rabbits were divided into 3 groups,undergoing respectively gallbladder duct closure by titanium clips, absorbable clips and silk suture, 2,4,6 months later the tissues around operation area were examined by routine and elctronographic morphological method.[WT5”HZ] Results[WT5”BZ] (1) 29 patients in titanium clips group showed metallic image and interference during CT, and no one was found with such abnormality in the absorbable clips group. The general morphological examination of the experimental animals revealed that encapsulated tissue were minimum in titanium clip group, but were maximum in absorbable groups; Moreover, the abnormal brown sediment around the secondary lysosome with high electronic density in liver cell were increased signifieantly in titanium clips group ( P <0 01).[WT5”HZ] Conclusion[WT5”BZ] It is safe and reliable for the ligation of cystic duct or hemostasis by absorbable clips in LC. The clips had a minimum irritating and damage to the tissue around them than titanium clips. [WT5”HZ]

关 键 词：胆囊切除术 腹腔镜 钛夹 可吸收夹 材料试验 

分 类 号：R657.4[医药卫生—外科学]