通道鞘对模拟微创保胆取石术中兔胆囊腔内压力的影响

THE EFFECT ON THE PRESSURE OF GALLBLADDER DURING MINIMALLY CHOLECYSTOTOMY IN RABBIT BY USING A SHEATH

目的探讨微创保胆取石手术中使用通道鞘对胆囊腔内压力的影响。方法将12只大白兔随机分为A、B两组。全部模拟进行微创保胆取石手术。A组术中不使用通道鞘,B组术中使用通道鞘。采用多通道生理仪连续记录胆囊腔内压力。采用SPSS 16.0比较A、B两组兔的体重和术中胆囊腔内压力差异,以独立两样本的t检验,双尾,a=0.05。结果两组兔的体重和开始灌注前胆囊腔内的压力差异都没有统计学意义(体重15.1±1.2 kg与16.1±0.9 kg,t=1.601,p=0.140;灌注前压力6.4±0.6 mm Hg与6.7±1.0 mm Hg,t=0.607,p=0.557)。A组没有使用通道鞘,灌注后胆囊腔内压力快速上升,压力较高时,胆囊壁明显变薄、半透亮、出现水肿现象。最高压力达43.2mm Hg(39.4±2.3 mm Hg),在最高压力后,胆囊镜与胆囊壁之间出现明显漏水,随后压力明显降低,然后趋于平稳。B使用通道鞘,灌注后胆囊腔内压力缓慢上升,最高压力28.7 mm Hg(24.5±2.8 mm Hg),通道鞘与胆囊壁之间没有出现明显漏水,胆囊腔内压力总体比较平稳,且胆囊壁外观没有明显变化。经过SPSS 16.0,采用两样本t检验分析,灌注后胆囊腔内平均压力和最高压力的差异都有统计学意义(39.4±2.3 mm Hg与24.5±2.8 mm Hg,t=10.174,p=0.000;12.4±0.9 mm Hg与6.5±0.4 mm Hg,t=14.129,p=0.000)。结论采用通道鞘可以有效降低微创保胆取石手术中胆囊腔内的压力,减轻术中液体灌注对胆囊的压力刺激,利于保护胆囊。

Objective To investigate the variation of the pressure within gallbladder during minimally cholecystotomy with or without using a sheath. Method There were 12 rabbits assigned randomly into two groups（ A and B group）. One 7F central venous catheter was adopted to penetrate into the gallbladder through liver. The pressure were recorded through multi- channels electrophysiological polygraph. Independent Samples Test in SPSS 16.0 was used to analysis these values of pres- sure. Result The pressure of gallbladder before perfusion was 6.4 ± 0. 6 mmHg in group A and 6. 7 ± 1.0 mmHg in group B （ t =0. 607, p = 0. 557 ）. There is a different significance between two groups in the hightest pressure and the average pres- sure after perfusion（ 39.4±2. 3 mmHg verse 24. 5 ：t： 2. 8mmHg, t = 10. 174, p = 0. 000; 12. 4 ± 0. 9mmHg verse 6.5 ± 0. 4mmHg, t = 14. 129, p =0. 000）. The water began to flow into the abdominal cavity out of the gallbladder after the hightest pressure（g3.2 mmHg）, and then the gallbladder wall became thinner and dropsy. Conclusion It suggests to use a sheath in the minimally cholecystotomy because of the pressure of the gallbladder during the operation will be degraded while the chole- cystoscope going through a sheath into gallbladder.