腹腔镜胆总管探查术前是否应预防性胃肠减压  

Is prophylactic gastrointestinal decompression necessary in patients undergoing laparoscopic common bile duct exploration?

作　　者：霍成龙 邓岩 王帅[1] 朱振新[1] 孙振纲[1] HUO Chenglong;DENG Yan;WANG Shuai;ZHU Zhenxin;SUN Zhengang(Department of Hepatobiliary,Pancreatic,and Splenic Surgery,Jingzhou Central Hospital,The Second Clinical Medical College,Yangtze University,Jingzhou,Hubei 434020,P.R.China)

机构地区：[1]荆州市中心医院肝胆胰脾外科长江大学第二临床医学院,湖北荆州434020

出　　处：《中国普外基础与临床杂志》2019年第4期443-447,共5页Chinese Journal of Bases and Clinics In General Surgery

摘　　要：目的评估腹腔镜胆总管探查(LCBDE)术前是否应该常规预防性胃肠减压。方法对2016年1月至2017年12月期间因胆总管结石合并胆囊结石就诊于荆州市中心医院拟行LCBDE加腹腔镜胆囊切除术的患者进行前瞻性研究。所有患者由同一研究人员按随机数字表法随机将其分别纳入胃肠减压组和非胃肠减压组,比较2组患者的一般状况、术中及术后恢复情况。结果本研究共纳入286例患者,其中非胃肠减压组120例,胃肠减压组166例。2组患者一般资料如年龄、性别、吸烟史、饮酒史、术前合并症、术前实验室检查结果及麻醉评分比较差异均无统计学意义(P>0.050)。非胃肠减压组患者术后经口进食时间明显早于胃肠减压组(t=2.181,P=0.030),2组患者的术中出血量、手术时间、肛门通气时间、总住院时间和术后住院时间比较差异均无统计学意义(P>0.050)。非胃肠减压组患者术后出现恶心/呕吐及食欲不振的发生率明显低于胃肠减压组患者(χ2=5.098,P=0.024;χ2=4.905,P=0.027),2组患者的其他并发症发生率比较差异无统计学意义(P>0.050)。结论本研究结果提示,LCBDE术前患者不建议常规行预防性胃肠减压。Objective To investigate safety and feasibility of laparoscopic common bile duct exploration(LCBDE)without preoperative prophylactic gastrointestinal decompression.Methods A prospective study was conducted on the patients with choledochoHthiasis and cholecystolithiasis scheduled to undergo LCBDE plus laparoscopic cholecystectomy in this hospital from January 2016 to December 2017.All the patients were randomly divided into a gastrointestinal decompression group and a non-gastrointestinal decompression group by the same researcher according to the random number table method.The general conditions,intraoperative status and postoperative status of patients in the two groups were compared.Results A total of 286 patients were enrolled in this study,including 120 in the non-gastrointestinal decompression group and 166 in the gastrointestinal decompression group.There were no significant differences in the general data such as the age,gender,smoking history,drinking history,preoperative complications,results of preoperative laboratory examination,and preoperative anesthesia score between the two groups(P>0.050).The time of oral feeding in the non-gastrointestinal decompression group was significantly earlier than that in the gastrointestinal decompression group(t=2.181,P=0.030).There were no significant differences in the bleeding volume,operative time,anal ventilation time,total hospitalization time,and postoperative hospitalization time between the two groups(P>0.050).The incidences of nausea/vomiting and poor appetite in the non-gastrointestinal decompression were significantly lower than those in the gastrointestinal decompression group(χ^2=5.09&P=0.024;χ^2=4.905,P=0.027).There were no significant differences in the incidences of other complications between the two groups(P>0.050).Conclusion From results of this study,prophylactic gastrointestinal decompression should not be recommended for patients undergoing LCBDE.

关 键 词：胃肠减压 腹腔镜胆总管探查 加速康复外科 预后 

分 类 号：R657.4[医药卫生—外科学]