经胆囊管细管引流测胆道压力对胆总管切开一期缝合的指导意义

Significance of Bile Duct Pressure Measurement Through Trans-cystic Fine Tube on Choledochotomy and Primary Suture

目的通过经胆囊管细管引流测量术后不同时间患者的胆道压力,观察是否存在术后压力持续增高。方法 2013年1月~2014年6月对52例行腹腔镜胆囊切除,胆总管切开取石一期缝合术行胆道压力测定。采用经胆囊管留置细管进入胆道进行测压,通过中心静脉压的装置测量,分别测定术后第3、7、11天胆道压力。结果 3例术后第3天出现胆漏,第6天消失。所有患者顺利出院,无并发症。术后第3、7、11天胆道压力分别为(20.49±1.44)、(16.09±1.48)、(11.29±1.74)cm H2O,两两比较均有统计学差异(P均=0.000)。结论腹腔镜下胆囊切除,胆总管切开取石一期缝合术后胆道压力逐渐降低,胆漏最可能在术后3 d左右发生,术后第7、11天后胆漏的机会明显减少。一期缝合的病人出院时并不增加胆道压力,不增加出院后胆漏风险。

Objective To measure the bile duct pressure at different postoperative days through trans-cystic fine tube to observe whether the bile duct pressure is continuously elevated after choledochotomy and primary suture. Methods From January2013 to June 2014,52 patients undergoing laparoscopic cholecystectomy with choledochotomy and primary suture were included. A fine tube was put through the cystic tube intra-operatively. The bile duct pressures at postoperative 3,7,and 11 days were evaluated through the trans-cystic tube with a device used to measure the central venous pressure. Results Bile leakage occurred in 3 patients at postoperative 3 days and was resolved at 6 days postoperatively. All the patients were discharged from hospital smoothly without complications. The bile duct pressures were（ 20. 49 ± 1. 44）,（ 16. 09 ± 1. 48）,and（ 11. 29 ± 1. 74） cm H_2O at postoperative 3,7,and 11 days,with significant differences between each other（ P = 0. 000）. Conclusions Bile duct pressure gradually decreases after laparoscopic cholecystectomy with choledochotomy and primary suture. Bile leakage is more likely to occur at 3 days than 7 and 11 days after the surgery. Bile duct pressure and postoperative bile leakage are not prone to be increased after primary suture.