腹腔镜胆总管切开取石术对患者术后胃肠道功能恢复、应激反应及血流动力学的影响_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

方大正 ,  沈丰 , 吴宏伟 , 李浩

湖北医药学院附属东风医院普外科（湖北十堰 442008）;

Corresponding author：

沈丰, Email: shenf7683@163.com

Keywords：

胆总管结石; 胆总管切开取石术; 腹腔镜; 应激反应; 血流动力学

DOI：

10.7507/1007-9424.201704090

Video：

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目的探讨腹腔镜胆总管切开取石术对患者术后胃肠道功能恢复、应激反应及血流动力学的影响。方法回顾性分析笔者所在医院于 2016 年 1 月至 2016 年 12 月期间收治的 78 例胆总管结石患者的临床资料，按照术式分为开腹组（行开腹胆总管切开取石术）与腹腔镜组（行腹腔镜胆总管切开取石术），各 39 例，比较 2 组患者的手术疗效、手术前后的应激反应指标和血流动力学指标。结果腹腔镜组患者的术中出血量、术后镇痛次数、胃肠道功能恢复时间及术后住院时间均少于（短于）开腹组（P<0.01）；腹腔镜组手术前后的血清皮质醇水平、血清游离三碘甲状腺原氨酸（FT3）水平及平均动脉压（MAP）的差值均较开腹组低（P<0.05），而手术前后心率（HR）的差值较开腹组高（P<0.05）。结论相比开腹胆总管切开取石术，腹腔镜胆总管切开取石术更利于改善患者的血清皮质醇及 FT3 水平，减轻应激反应，改善血流动力学情况，促进术后胃肠道功能的恢复，值得临床推广。

Citation： 方大正, 沈丰, 吴宏伟, 李浩. 腹腔镜胆总管切开取石术对患者术后胃肠道功能恢复、应激反应及血流动力学的影响. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2017, 24(12): 1513-1516. doi: 10.7507/1007-9424.201704090 Copy

1.	Gupta V, Chandra A. Duplication of the extrahepatic bile duct. Congenit Anom (Kyoto), 2012, 52(3): 176-178.
2.	Liang H, Zhang C, Zhang H. Study on suture of patients with history of abdominal surgery after laparoscopic choledocholithotomy. Pak J Pharm Sci, 2015, 28(6 Suppl): 2285-2289.
3.	郭永胜, 李国栋. 腹腔镜胆总管切开取石并一期缝合治疗胆总管结石的临床研究. 中国医药导报, 2013, 10(12): 65-67.
4.	陈新桂, 黄河, 杨培生, 等. 腹腔镜下胆总管切开取石术治疗胆总管结石患者的临床研究. 中华肝脏外科手术学电子杂志, 2013, 2(1): 25-29.
5.	Yokoyama K, Tanigawa N, Ogata A, et al. Laparoscopic technique and initial experiences of choledocholithotomy closure with knotless unidirectional barbed sutures after surgery for biliary stone disease. Surg Laparosc Endosc Percutan Tech, 2015, 25(4): e129-e133.
6.	江永强, 曹辉, 张军, 等. 腹腔镜胆道手术用于胆总管结石治疗的临床研究. 中国临床保健杂志, 2012, 15(4): 383-384.
7.	Suzuki K, Higuchi H, Shimizu S, et al. Endoscopic snare papillectomy for a solitary Peutz-Jeghers-type polyp in the duodenum with ingrowth into the common bile duct: case report. World J Gastroenterol, 2015, 21(26): 8215-8220.
8.	Sinha R, Chandra S. Cystic duct leaks after laparoendoscopic single-site cholecystectomy. J Laparoendosc Adv Surg Tech A, 2012, 22(6): 533-537.
9.	陆锦俊, 孙跃明. 腹腔镜胆总管切开取石一期缝合与 T 管引流治疗胆总管结石的临床疗效比较. 腹腔镜外科杂志, 2014, 19(12): 912-916.
10.	Sinha R. Laparoscopic choledocholithotomy with rigid nephroscope. J Laparoendosc Adv Surg Tech A, 2013, 23(3): 211-215.
11.	梁永任, 黄燕金, 梁日光, 等. LBEPS 与 LCTD 治疗胆总管结石的临床对比研究. 中国医药导报, 2013, 10(20): 51-53, 57.
12.	Zhan X, Wang Y, Zhu J, et al. Laparoscopic choledocholithotomy with a novel articulating forceps. Surg Innov, 2016, 23(2): 124-129.
13.	孔志远, 李凯, 尚红刚. 腹腔镜胆总管切开取石术临床疗效分析. 中国实用医药, 2012, 7(31): 90-91.
14.	Wang B, Ding YM, Nie YG, et al. The clinical evaluation of laparoscopic transcystic duct common bile duct exploration in elderly choledocholithiasis. Hepatogastroenterology, 2014, 61(132): 892-896.
15.	詹国庆, 竹锡锋, 李峰. 腹腔镜胆总管切开取石术治疗细径胆总管结石 73 例. 海军医学杂志, 2012, 33(4): 244-247.
16.	陈合群, 晁志涛, 蔺正印. 胆总管结石患者行腹腔镜下胆总管切开取石术治疗的疗效及安全性分析. 现代消化及介入诊疗, 2016, 21(3): 465-467.
17.	银珍, 孙维华. 腹腔镜胆总管切开取石术治疗有胆道手术史肝胆管结石的安全性分析. 中外医疗, 2015, 34(28): 1-3.
18.	马学强, 陈祝华, 陈刚红. 腹腔镜胆总管切开取石术对患者血液流变学及免疫球蛋白的影响. 肝胆胰外科杂志, 2016, 28(6): 506-508.
19.	Amikura K, Sakamoto H, Takahashi A, et al. Useful device for hepatectomy in patients with a surgical history of bile duct-GI tract anastomosis at the porta hepatis. Gan To Kagaku Ryoho, 2014, 41(12): 1497-1499.
20.	黄有星, 钟小生, 何军明, 等. 腹腔镜胆总管切开取石术在有胆道手术史的胆总管结石患者中的应用. 实用临床医药杂志, 2015, 19(11): 97-98.
21.	杨定华. 腹腔镜胆总管切开取石术在有胆道手术史肝胆管结石患者中的应用效果. 按摩与康复医学, 2015, 6(12): 41-42.
22.	Sartin BE, Zheleznev SI, Pivkin AN. Simultaneous surgical mithral-tricuspidal insufficiency correction and cholecystectomy with choledocholithotomy by acute cholangitis. Khirurgiia (Mosk), 2013, (1): 76-79.
23.	邵伟怡, 宋振顺. 胆囊结石合并胆总管结石不同手术方式的选择. 中国现代普通外科进展, 2016, 19(11): 885-888.
24.	钟立明, 冷希圣, 王秋生, 等. 纤维胆道镜在腹腔镜胆总管切开取石术中的应用. 中国微创外科杂志, 2006, 6(6): 433-435.
25.	Masuda Y, Mizuguchi Y, Kanda T, et al. Successful treatment of limy bile syndrome extending to the common bile duct by laparoscopic cholecystectomy and common bile duct exploration: a case report and literature review. Asian J Endosc Surg, 2017, 10(1): 59-62.

1. Gupta V, Chandra A. Duplication of the extrahepatic bile duct. Congenit Anom (Kyoto), 2012, 52(3): 176-178.
2. Liang H, Zhang C, Zhang H. Study on suture of patients with history of abdominal surgery after laparoscopic choledocholithotomy. Pak J Pharm Sci, 2015, 28(6 Suppl): 2285-2289.
3. 郭永胜, 李国栋. 腹腔镜胆总管切开取石并一期缝合治疗胆总管结石的临床研究. 中国医药导报, 2013, 10(12): 65-67.
4. 陈新桂, 黄河, 杨培生, 等. 腹腔镜下胆总管切开取石术治疗胆总管结石患者的临床研究. 中华肝脏外科手术学电子杂志, 2013, 2(1): 25-29.
5. Yokoyama K, Tanigawa N, Ogata A, et al. Laparoscopic technique and initial experiences of choledocholithotomy closure with knotless unidirectional barbed sutures after surgery for biliary stone disease. Surg Laparosc Endosc Percutan Tech, 2015, 25(4): e129-e133.
6. 江永强, 曹辉, 张军, 等. 腹腔镜胆道手术用于胆总管结石治疗的临床研究. 中国临床保健杂志, 2012, 15(4): 383-384.
7. Suzuki K, Higuchi H, Shimizu S, et al. Endoscopic snare papillectomy for a solitary Peutz-Jeghers-type polyp in the duodenum with ingrowth into the common bile duct: case report. World J Gastroenterol, 2015, 21(26): 8215-8220.
8. Sinha R, Chandra S. Cystic duct leaks after laparoendoscopic single-site cholecystectomy. J Laparoendosc Adv Surg Tech A, 2012, 22(6): 533-537.
9. 陆锦俊, 孙跃明. 腹腔镜胆总管切开取石一期缝合与 T 管引流治疗胆总管结石的临床疗效比较. 腹腔镜外科杂志, 2014, 19(12): 912-916.
10. Sinha R. Laparoscopic choledocholithotomy with rigid nephroscope. J Laparoendosc Adv Surg Tech A, 2013, 23(3): 211-215.
11. 梁永任, 黄燕金, 梁日光, 等. LBEPS 与 LCTD 治疗胆总管结石的临床对比研究. 中国医药导报, 2013, 10(20): 51-53, 57.
12. Zhan X, Wang Y, Zhu J, et al. Laparoscopic choledocholithotomy with a novel articulating forceps. Surg Innov, 2016, 23(2): 124-129.
13. 孔志远, 李凯, 尚红刚. 腹腔镜胆总管切开取石术临床疗效分析. 中国实用医药, 2012, 7(31): 90-91.
14. Wang B, Ding YM, Nie YG, et al. The clinical evaluation of laparoscopic transcystic duct common bile duct exploration in elderly choledocholithiasis. Hepatogastroenterology, 2014, 61(132): 892-896.
15. 詹国庆, 竹锡锋, 李峰. 腹腔镜胆总管切开取石术治疗细径胆总管结石 73 例. 海军医学杂志, 2012, 33(4): 244-247.
16. 陈合群, 晁志涛, 蔺正印. 胆总管结石患者行腹腔镜下胆总管切开取石术治疗的疗效及安全性分析. 现代消化及介入诊疗, 2016, 21(3): 465-467.
17. 银珍, 孙维华. 腹腔镜胆总管切开取石术治疗有胆道手术史肝胆管结石的安全性分析. 中外医疗, 2015, 34(28): 1-3.
18. 马学强, 陈祝华, 陈刚红. 腹腔镜胆总管切开取石术对患者血液流变学及免疫球蛋白的影响. 肝胆胰外科杂志, 2016, 28(6): 506-508.
19. Amikura K, Sakamoto H, Takahashi A, et al. Useful device for hepatectomy in patients with a surgical history of bile duct-GI tract anastomosis at the porta hepatis. Gan To Kagaku Ryoho, 2014, 41(12): 1497-1499.
20. 黄有星, 钟小生, 何军明, 等. 腹腔镜胆总管切开取石术在有胆道手术史的胆总管结石患者中的应用. 实用临床医药杂志, 2015, 19(11): 97-98.
21. 杨定华. 腹腔镜胆总管切开取石术在有胆道手术史肝胆管结石患者中的应用效果. 按摩与康复医学, 2015, 6(12): 41-42.
22. Sartin BE, Zheleznev SI, Pivkin AN. Simultaneous surgical mithral-tricuspidal insufficiency correction and cholecystectomy with choledocholithotomy by acute cholangitis. Khirurgiia (Mosk), 2013, (1): 76-79.
23. 邵伟怡, 宋振顺. 胆囊结石合并胆总管结石不同手术方式的选择. 中国现代普通外科进展, 2016, 19(11): 885-888.
24. 钟立明, 冷希圣, 王秋生, 等. 纤维胆道镜在腹腔镜胆总管切开取石术中的应用. 中国微创外科杂志, 2006, 6(6): 433-435.
25. Masuda Y, Mizuguchi Y, Kanda T, et al. Successful treatment of limy bile syndrome extending to the common bile duct by laparoscopic cholecystectomy and common bile duct exploration: a case report and literature review. Asian J Endosc Surg, 2017, 10(1): 59-62.

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腹腔镜胆总管切开取石术对患者术后胃肠道功能恢复、应激反应及血流动力学的影响

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