改良T管置入术在腹腔镜联合胆道镜胆总管切开取石患者中的应用研究

Study on the Application of Modified T-tube Placement in Patients with Laparoscopic Combined Choledochoscopic Choledocholithotomy

目的:探究及分析改良T管置入术在腹腔镜联合胆道镜胆总管切开取石患者中的应用效果。方法:选取2018年10月-2021年10月新余市中医院80例腹腔镜联合胆道镜胆总管切开取石患者为研究对象,将其根据随机数字表法分为对照组和观察组,每组40例。对照组进行常规T管置入,观察组则进行改良T管置入。比较两组的T管置入耗费时间,术中出血量,术前、术中10 min及术后5 min的血流动力学指标[收缩压(SBP)、舒张压(DBP)及心率(HR)],应激激素[皮质醇(Cor)、去甲肾上腺素(NE)及醛固酮(ALD)]及并发症发生率。结果:观察组的T管置入耗费时间显著短于对照组,并发症发生率显著低于对照组,差异均有统计学意义(P<0.05)。两组术中出血量比较,差异无统计学意义(P>0.05)。术前,两组血流动力学指标及应激激素比较,差异均无统计学意义(P>0.05);术中10 min、术后5 min,观察组的血流动力学指标及应激激素均显著低于对照组,差异均有统计学意义(P<0.05)。结论:改良T管置入术有助于腹腔镜联合胆道镜胆总管切开取石患者不良应激的控制,且患者的并发症发生率相对更低,且耗时更短,因此在本类手术患者中的应用价值较高。

Objective:To investigate and analyze the application effect of modified T-tube placement in patients with laparoscopic combined choledochoscopic choledocholithotomy.Method:A total of 80 patients with laparoscopic combined choledochoscopic choledocholithotomy in Xinyu Hospital of Traditional Chinese Medicine from October 2018 to October 2021 were chosen as the study objects,and they were divided into control group and observation group,with 40 cases in each group according to random number table.The control group was treated with conventional T-tube placement,the observation group was treated with modified T-tube placement.Then the T-tube placement time,intraoperative blood loss,hemodynamics indexes[systolic blood pressure (SBP),diastolic blood pressure (DBP) and heart rate (HR)]and stress hormones[cortisol (COR),norepinephrine (NE) and aldosterone (ALD)]before the operation,at 10 min during the operation and 5 min after the operation,complication rates of two groups were compared.Result:The T-tube placement time of observation group was significantly shorter than that of control group,the complication rate was significantly lower than that of control group,there were statistically significant differences (P<0.05).The intraoperative blood loss of two groups were compared,there were no statistically significant difference (P>0.05).The hemodynamics indexes and stress hormones of two groups were compared before the operation,there were no statistically significant differences (P>0.05);the hemodynamics indexes and stress hormones of observation group at 10 min during the operation and 5 min after the operation were significantly lower than those of control group,there were statistically significant differences (P<0.05).Conclusion:The modified T-tube placement is helpful to the control of adverse stress of patients with laparoscopic combined choledochoscopic choledocholithotomy,the time is shorter,and the complication rate is lower,so its application value in these patients is higher.