腹腔镜胆总管切开取石术中夹闭T管的临床分析

Clinical analysis of clamping of T tube during laparoscopic choledocholithotomy

目的评价腹腔镜胆总管切开术中夹闭T管的临床效果。方法选取2013年2月至2015年2月于河北北方学院附属第二医院行腹腔镜胆总管切开术置T管患者100例,分为T管开放组(A组)和T管夹闭组(B组),各50例,比较两组肝功能指标、电解质变化及术后胃肠道功能恢复情况。结果血清丙氨酸氨基转移酶(GPT)、碱性磷酸酶(ALP)、总胆红素(TBil)、直接胆红素(DBil)水平比较,术后第1天B组高于A组,差异有统计学意义(P<0.05);第3天起均有所下降,两组无明显差异(P>0.05)。术后第3天起A组清蛋白(Alb)水平开始降低,且A组低于B组,差异有统计学意义(P<0.05)。B组术后各时间点血钾离子(K^+)、钠离子(Na^+)、氯离子(Cl^-)水平无明显下降;术后第3天起,A组K^+、Na^+水平均下降,但仍维持在正常范围内,两组K^+、Na^+、Cl^-水平比较,差异有统计学意义(P<0.05)。B组肛门首次排气时间及肠鸣音恢复时间早于A组,差异有统计学意义(P<0.05)。结论术中夹闭T型管不影响患者术后肝功能的恢复,有利于维持患者围术期内环境稳定及术后胃肠道功能的早期恢复。

Objective To evaluate the clinical effects of clamping of T tube during laparoscopic choledocholithotomy.Methods A total of 100 cases of patients with a T-tube placed in common bile duct during laparoscopic choledocholithotomy in the Second Affiliated Hospital of Hebei North University from February 2013 to February 2015 were selected.All patients were divided into the T tube opening group(group A)and the T tube clamping group(group B),50 cases in each group.The serum liver function indexes,change of electrolyte and postoperative recovery of gastrointestinal function between the two groups were compared.Results The serum levels of alanine aminotransferase(GPT),alkaline phosphatase(ALP),total bilirubin(TBil)and direct bilirubin(DBil)in group B were higher than those in group A on the first day after operation,and the differences were statistically significant(P<0.05).The levels of all the indexes mentioned above were slightly decreased from the third day after operation,and no statistically significant difference was found between the two groups(P>0.05).The level of ALB in group A began to decrease from the third day after operation,which was lower than that in group B,and the difference was statistically significant difference(P<0.05).The serum levels of K^+,Na^+and Cl^-in group B were not remarkably reduced at all time points after operation,while those in group A were slightly reduced from the third day after operation,but still maintained within normal range,and differences between the two groups were statistically significant(P<0.05).The time of first anus exhaust and borborygmus recovery time in group B were earlier than those in group A,and the differences were statistically significant(P<0.05).Conclusion Intraoperative clamping of the T-tube does not affect the recovery of the patients′postoperative liver function,which contributes to maintaining perioperative homeostasis,and is beneficial to the early recovery of postoperative gastrointestinal function.