腹腔镜与开腹胆囊切除胃肠压力变化的临床研究

The changes of gastrointestinal pressure after laparoscopic and open cholecystectomy

目的 :从胃肠道压力变化的角度探讨腹腔镜与开腹胆囊切除对胃肠运动功能的影响。方法 :腹腔镜胆囊切除 30例 (男 6例 ,女 2 4例 ,4 7± 4岁 ) ,开腹胆囊切除 30例 (男 9例 ,女 2 1例 ,4 7± 7岁 ) ,分别于手术前 1d行胃电图描记 ,记录术后 3、2 4、4 8、72h胃电图及监测胃窦、十二指肠和空肠压力 (移行性运动复合波 ,MMCⅢ )。结果 :(1)手术前腹腔镜和开腹胆囊切除患者胃电频率差异无显著性 (P >0 .0 5 ) ;(2 )腹腔镜胆囊切除组术后 3、2 4h正常波所占百分比低于术前 ,但差异无显著性 (P >0 .0 5 ) ,术后 4 8h恢复正常 ;(3)开腹胆囊切除组术后起 3h正常波所占百分比明显低于术前 ,差异有显著性 (P <0 .0 1) ,术后 2 4、4 8h正常波的百分比与术前差异无显著性 ,术后 72h恢复正常 ;(4) 2组患者术后胃窦、十二指肠及空肠压力低于健康人群 (P<0 .0 5 ) ;(5 ) 2组胃窦部收缩压力及收缩曲线下面积术后第 1、2、3d较术后 3h明显升高 (P <0 .0 5 ) ,且随时间延长有逐渐增大的趋势 ,腹腔镜组术后 72h恢复正常 ,十二指肠及空肠术后 3d内无明显变化 ;(6 ) 2组间胃电频率 ,胃窦部、十二指肠及空肠压力变化差异无显著性 (P >0 .0 5 ) ,但显示有差别。结论 :腹腔镜与开腹胆囊切除术均可引起胃电频率及胃肠压力变化 。

Objective:To investigate the mechanism and pathophysiologeal changes of gastrointestinal pressure in patients undergoing cholecystectomy of different sugical techiques.Methods:There were 30 patients (including 6 males and 24 females,mean age of 47±4 years) performed laparoscopic cholecystectomy (LC), and 30 patients(including 9 males and 21 femeals,mean age of 47±7 years) undergone open cholecystectomy (OC). Sixty patients after cholecystectomy were selected to perform cutaneous electrogastrograthy (EGG) one day before operation, and three hours, the first, the second and the third day after operation respectively. On the operative and postoperative days, gastroduodene and ejunal amnometry were measured in all patients. Results:(1)There were no statistical difference in the percentage of EGG frequency between two groups before operation. (2)The percentage of EGG normal frequency after LC was lower at the 3?24 hours postoperative than that on the preoperative day. But there was no significant difference. (3)The percentage of EGG normal frequency at three hours after OC was more significantly decreased than that on the preoperative day (P<0.01), there was no statistical difference between the preoperative day and the first, the second and the third postoperative day. (4)The contractile power and area of MMC at antrum, duodenum, and upper jejunum after operation were obviously lower than those on the normal population (P<0.05). (5)The contractile power and of MMC Ⅲ at antrum at 24 hours after operation were higher than that at 3 hours after operation. The statistical difference existed after LC and OC. (6)No significant difference existed in changes of the percentage of EGG frequency and gastrointestinal pressure between two groups.Conclusions:The present study showed that cutaneous electrogastrography and gastroduodene jejunal manometry were induced by LC and OC. The degree of the percentage of EGG normal frequency and the contractile power and the area of MMC Ⅲ at gastroenterics were more pronounced after OC and the time course was prolonged in OC. There was slight changes of electrogastrogram and gastrotestinal pressure following laparoscopic cholecystectomy.