摘要
目的 探讨小剂量地塞米松在腹腔镜下经胆囊管胆道探查(LTCBDE)围手术期中应用的效果及影响。方法 回顾性研究分析2021年1至2022年4月武汉大学人民医院行LTCBDE的97例胆囊结石合并胆总管结石患者临床资料。患者均签署知情同意书,符合医学伦理学规定。其中男44例,女53例;年龄17~86岁,中位年龄54岁。所有患者术前均行MRCP检查。根据围手术期是否使用小剂量地塞米松将患者分为地塞米松组(40例)和对照组(57例),地塞米松组在麻醉诱导前及术后第2天使用10 mg地塞米松静脉滴注,对照组不使用地塞米松及等效糖皮质激素(激素)类药物。观察患者围手术期结局。两组WBC、肝功能、疼痛视觉模拟法评分(VAS)比较采用t检验,术后恶心呕吐(PONV)、胆漏发生率比较采用χ^(2)检验。结果 两组均手术顺利,围手术期无死亡及其他严重并发症。地塞米松组术后WBC、ALT、AST、TB、DB、VAS平均为(8.8±2.4)×10^(9)/L、(58±9)U/L、(57±10)U/L、(41.4±6.4)μmol/L、(25.8±3.5)μmol/L、(2.3±0.9)分,均明显低于对照组的(10.0±2.1)×10^(9)/L、(55±10)U/L、(44±7)U/L、(43.0±5.3)μmol/L、(27.0±2.1)μmol/L、(3.9±0.5)分(t=-2.61,-1.87,-6.27,-6.72,-2.08,-8.19;P<0.05)。地塞米松组术后PONV发生率18% (7/40),明显低于对照组的37%(21/57) (χ^(2)=4.28,P<0.05);而两组胆漏分别为3、6例,发生率差异无统计学意义(χ^(2)=0.26,P>0.05)。结论 围手术期应用小剂量地塞米松有助于降低LTCBDE术后疼痛、恶心呕吐的发生率,改善患者术后肝功能,降低术后炎症反应水平,且不增加并发症发生率。
Objective To evaluate the efficacy and effect of low-dose dexamethasone during perioperative period of laparoscopic transcystic common bile duct exploration (LTCBDE).Methods Clinical data of 97 patients with cholecystolithiasis complicated with choledocholithiasis who underwent LTCBDE in Renmin Hospital of Wuhan University from January 2021 to April 2022 were retrospectively analyzed.The informed consents of all patients were obtained and the local ethical committee approval was received.Among them,44 patients were male and 53 female,aged from 17 to 86 years,with a median age of 54 years.All patients received magnetic resonance cholangiopancreatography (MRCP) before surgery.All patients were divided into the dexamethasone (n=40) and control groups (n=57) according to whether low-dose dexamethasone was used during perioperative period.In the dexamethasone group,10 mgintravenous dose of dexamethasone was given before anesthesia induction and at postoperative 2 day,whereas dexamethasone or equivalent glucocorticoid drugs (hormones) were not used in the control group.Perioperative outcomes of all patients were observed.The WBC liver function and visual analogue scale (VAS) score were compared by t test between two groups.The incidence of postoperative nausea and vomiting (PONV) and bile leakage was compared by Chi-square test.Results LTCBDE was successfully performed in two groups.No death or other serious complications were reported during perioperative period.The average WBC,ALT,AST,TB,DB and VAS score in the dexamethasone group were (8.8±2.4)×10^(9)/L,(58±9) U/L,(57±10) U/L,(41.4±6.4) μmol/L,(25.8±3.5)μmol/L and 2.3±0.9,significantly lower than (10.0±2.1)×10^(9)/L,(55±10) U/L,(44±7) U/L,(43.0±5.3) μmol/L,(27.0±2.1) μmol/Land 3.9±0.5 in the control group (t=-2.61,-1.87,-6.27,-6.72,-2.08,-8.19;P<0.05).The incidence of PONV in the dexamethasone group was 18%(7/40),significantly lower than 37%(21/57) in the control group (χ2=4.28,P<0.05).3 and 6 patients developed bile leakage in two groups,and ther
作者
朱垒
汪斌
张爱民
陈晓燕
张艳冰
齐浩龙
Zhu Lei;Wang Bin;Zhang Aimin;Chen Xiaoyan;Zhang Yanbing;Qi Haolong(Department of Hepatobiliary Surgery,Renmin Hospital of Wuhan University,Wuhan 430060,China)
出处
《中华肝脏外科手术学电子杂志》
CAS
2024年第3期339-343,共5页
Chinese Journal of Hepatic Surgery(Electronic Edition)
基金
湖北省重点实验室开放项目(2021KFY018)。
关键词
地塞米松
腹腔镜下经胆囊管胆道探查
围手术期
术后并发症
Dexamethasone
Laparoscopic transcystic common bile duct exploration
Perioperativeperiod
Postoperative complications
