腹腔鏡膽總管切開取石術對患者術后胃腸道功能恢復、應激反應及血流動力學的影響_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

方大正 ,  沈豐 , 吳宏偉 , 李浩

湖北醫藥學院附屬東風醫院普外科（湖北十堰 442008）;

Corresponding?author：

沈豐, Email: shenf7683@163.com

Keywords：

膽總管結石; 膽總管切開取石術; 腹腔鏡; 應激反應; 血流動力學

DOI：

10.7507/1007-9424.201704090

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目的探討腹腔鏡膽總管切開取石術對患者術后胃腸道功能恢復、應激反應及血流動力學的影響。方法回顧性分析筆者所在醫院于 2016 年 1 月至 2016 年 12 月期間收治的 78 例膽總管結石患者的臨床資料，按照術式分為開腹組（行開腹膽總管切開取石術）與腹腔鏡組（行腹腔鏡膽總管切開取石術），各 39 例，比較 2 組患者的手術療效、手術前后的應激反應指標和血流動力學指標。結果腹腔鏡組患者的術中出血量、術后鎮痛次數、胃腸道功能恢復時間及術后住院時間均少于（短于）開腹組（P<0.01）；腹腔鏡組手術前后的血清皮質醇水平、血清游離三碘甲狀腺原氨酸（FT3）水平及平均動脈壓（MAP）的差值均較開腹組低（P<0.05），而手術前后心率（HR）的差值較開腹組高（P<0.05）。結論相比開腹膽總管切開取石術，腹腔鏡膽總管切開取石術更利于改善患者的血清皮質醇及 FT3 水平，減輕應激反應，改善血流動力學情況，促進術后胃腸道功能的恢復，值得臨床推廣。

Citation： 方大正, 沈豐, 吳宏偉, 李浩. 腹腔鏡膽總管切開取石術對患者術后胃腸道功能恢復、應激反應及血流動力學的影響. 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.	郭永勝, 李國棟. 腹腔鏡膽總管切開取石并一期縫合治療膽總管結石的臨床研究. 中國醫藥導報, 2013, 10(12): 65-67.
4.	陳新桂, 黃河, 楊培生, 等. 腹腔鏡下膽總管切開取石術治療膽總管結石患者的臨床研究. 中華肝臟外科手術學電子雜志, 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.	江永強, 曹輝, 張軍, 等. 腹腔鏡膽道手術用于膽總管結石治療的臨床研究. 中國臨床保健雜志, 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.	陸錦俊, 孫躍明. 腹腔鏡膽總管切開取石一期縫合與 T 管引流治療膽總管結石的臨床療效比較. 腹腔鏡外科雜志, 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, 黃燕金, 梁日光, 等. LBEPS 與 LCTD 治療膽總管結石的臨床對比研究. 中國醫藥導報, 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.	孔志遠, 李凱, 尚紅剛. 腹腔鏡膽總管切開取石術臨床療效分析. 中國實用醫藥, 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.	詹國慶, 竹錫鋒, 李峰. 腹腔鏡膽總管切開取石術治療細徑膽總管結石 73 例. 海軍醫學雜志, 2012, 33(4): 244-247.
16.	陳合群, 晁志濤, 藺正印. 膽總管結石患者行腹腔鏡下膽總管切開取石術治療的療效及安全性分析. 現代消化及介入診療, 2016, 21(3): 465-467.
17.	銀珍, 孫維華. 腹腔鏡膽總管切開取石術治療有膽道手術史肝膽管結石的安全性分析. 中外醫療, 2015, 34(28): 1-3.
18.	馬學強, 陳祝華, 陳剛紅. 腹腔鏡膽總管切開取石術對患者血液流變學及免疫球蛋白的影響. 肝膽胰外科雜志, 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.	黃有星, 鐘小生, 何軍明, 等. 腹腔鏡膽總管切開取石術在有膽道手術史的膽總管結石患者中的應用. 實用臨床醫藥雜志, 2015, 19(11): 97-98.
21.	楊定華. 腹腔鏡膽總管切開取石術在有膽道手術史肝膽管結石患者中的應用效果. 按摩與康復醫學, 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.	邵偉怡, 宋振順. 膽囊結石合并膽總管結石不同手術方式的選擇. 中國現代普通外科進展, 2016, 19(11): 885-888.
24.	鐘立明, 冷希圣, 王秋生, 等. 纖維膽道鏡在腹腔鏡膽總管切開取石術中的應用. 中國微創外科雜志, 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. 郭永勝, 李國棟. 腹腔鏡膽總管切開取石并一期縫合治療膽總管結石的臨床研究. 中國醫藥導報, 2013, 10(12): 65-67.
4. 陳新桂, 黃河, 楊培生, 等. 腹腔鏡下膽總管切開取石術治療膽總管結石患者的臨床研究. 中華肝臟外科手術學電子雜志, 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. 江永強, 曹輝, 張軍, 等. 腹腔鏡膽道手術用于膽總管結石治療的臨床研究. 中國臨床保健雜志, 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. 陸錦俊, 孫躍明. 腹腔鏡膽總管切開取石一期縫合與 T 管引流治療膽總管結石的臨床療效比較. 腹腔鏡外科雜志, 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, 黃燕金, 梁日光, 等. LBEPS 與 LCTD 治療膽總管結石的臨床對比研究. 中國醫藥導報, 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. 孔志遠, 李凱, 尚紅剛. 腹腔鏡膽總管切開取石術臨床療效分析. 中國實用醫藥, 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. 詹國慶, 竹錫鋒, 李峰. 腹腔鏡膽總管切開取石術治療細徑膽總管結石 73 例. 海軍醫學雜志, 2012, 33(4): 244-247.
16. 陳合群, 晁志濤, 藺正印. 膽總管結石患者行腹腔鏡下膽總管切開取石術治療的療效及安全性分析. 現代消化及介入診療, 2016, 21(3): 465-467.
17. 銀珍, 孫維華. 腹腔鏡膽總管切開取石術治療有膽道手術史肝膽管結石的安全性分析. 中外醫療, 2015, 34(28): 1-3.
18. 馬學強, 陳祝華, 陳剛紅. 腹腔鏡膽總管切開取石術對患者血液流變學及免疫球蛋白的影響. 肝膽胰外科雜志, 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. 黃有星, 鐘小生, 何軍明, 等. 腹腔鏡膽總管切開取石術在有膽道手術史的膽總管結石患者中的應用. 實用臨床醫藥雜志, 2015, 19(11): 97-98.
21. 楊定華. 腹腔鏡膽總管切開取石術在有膽道手術史肝膽管結石患者中的應用效果. 按摩與康復醫學, 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. 邵偉怡, 宋振順. 膽囊結石合并膽總管結石不同手術方式的選擇. 中國現代普通外科進展, 2016, 19(11): 885-888.
24. 鐘立明, 冷希圣, 王秋生, 等. 纖維膽道鏡在腹腔鏡膽總管切開取石術中的應用. 中國微創外科雜志, 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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腹腔鏡膽總管切開取石術對患者術后胃腸道功能恢復、應激反應及血流動力學的影響

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