ERCP术行胆汁引流对腹腔镜下胆囊切除术术后恶心呕吐的影响

Influence of ERCP-Guided Biliary Drainage on Nausea and Vomiting after Laparoscopic Cholecystectomy

目的探讨逆行胰胆管造影(ERCP)行胆汁引流后对腹腔镜下胆囊切除术(LC)患者术后恶心呕吐(PONV)的影响。方法选取526例胆囊结石患者,其中合并肝外胆总管结石89例(ERCP术后行LC术,观察组);单纯结石性胆囊炎患者437例,根据性别、年龄(±5岁)、是否吸烟、术中阿片类药物使用总量等指标进行11分层匹配得出对照组89例(单纯LC术)。对2组术后3、6、12、24h恶心呕吐进行评分(视觉模拟评分法,VAS),并比较2组术后各时段(0~6h、>6~12h、>12~24h)VAS>4分(中重度PONV)的发生率。结果观察组术后3、6、12、24h的VAS评分低于对照组(P<0.05),术后各时段VAS>4分的发生率亦低于对照组(P<0.05)。结论ERCP术行胆汁引流能够降低LC术PONV的发生率,其原因可能与ERCP术行胆汁引流能够减少胆汁反流入胃有关。

Objective To investigate the effect of endoscopic retrograde cholangiopancreatography（ERCP）-guided biliary drainage on postoperative nausea and vomiting（PONV）after laparoscopic cholecystectomy（LC）.Methods Eighty-nine patients with extrahepatic bile duct stones who underwent LC after ERCP were selected from 526 cholecystolithiasis patients as the observation group.In addition,according to the gender,age（±5 years）,smoking status and intraoperative opioid use,89 patients who received LC only were selected from 437 patients with calculous cholecystitis by 11 hierarchical matching as the control group.The PONV was assessed using visual analogue scale（VAS）3,6,12 hours and 24 hours after operation.The incidences of VAS4 within 0-6 hours,6-12 hours and 12-24 hours after treatment were compared between the two groups.Results Compared with control group,VAS scores at 3,6,12 and 24 hours after operation and incidences of VAS4 within 0-6,6-12 and 12-24 hours after treatment significantly decreased in observation group（P〈0.05）.Conclusion ERCP-guided biliary drainage can reduce the incidence of PONV after LC via a mechanism that may be involved in the decrease in biliary regurgitation.