摘要
目的探讨自制纱布条在降低腹腔镜胆总管探查术(LCBDE)治疗肝内胆管结石术后残石率的应用效果。方法选取2020年7月至2023年1月上饶市中心医院普外科收治的40例经计算机断层扫描(CT)、磁共振成像(MRI)、磁共振胰胆管造影(MRCP)确诊为胆总管结石合并肝内胆管多发结石的患者作为研究对象,采用随机数字表法将其分为塞纱布条组和不塞纱布条组,每组各20例。两组患者均进行LCBDE手术治疗,塞纱布条组患者在胆总管结石取干净后,准备进行胆道镜探查治疗肝内胆管结石前,采用自制纱布条对胆总管下段进行填塞,不塞纱布条组则不采用纱布条填塞。比较两组患者治疗情况(手术时间、术后排气时间、经T管胆道镜下碎石取石次数、住院时间);比较术前、术后3 d时两组患者肠道屏障功能水平(D-乳酸、内毒素);比较两组患者术后6个月复查时残石率。结果塞纱布条组手术时间、术后排气时间、住院时间短于不塞纱布条组,经T管胆道镜下碎石取石次数少于不塞纱布条组,差异有统计学意义(P<0.05)。术后3 d,两组患者D-乳酸、内毒素水平高于本组术前,塞纱布条组D-乳酸、内毒素水平低于不塞纱布条组,差异有统计学意义(P<0.05)。术后6个月复查时,塞纱布条组患者残石率低于不塞纱布条组,差异有统计学意义(P<0.05)。结论自制纱布条用于LCBDE治疗肝内胆管结石术中,可有效缩短手术时间,促进患者术后胃肠功能恢复,并有效降低术后的残石率,值得临床推广应用。
Objective To investigate the effect of self-made gauze strip in reducing the residual stone rate after laparoscopic common bile duct exploration(LCBDE)for intrahepatic cholelithiasis.Methods A total of 40 patients diagnosed with choledocholithiasis combined with multiple intrahepatic bile duct stones by computed tomography(CT),magnetic resonance imaging(MRI)and magnetic resonance cholangiopancreatography(MRCP)admitted to the Department of General Surgery of Shangrao Central Hospital from July 2020 to January 2023 were selected as the study objects,they were divided into gauze strip group and non-gauze strip group according to random number table method,with 20 cases in each group.Both groups underwent LCBDE surgery.After choledocholithiasis was removed,self-made gauze strip was used to fill the lower segment of the common bile duct before choledocholithiasis exploration and treatment by choledochoscopy in gauze strip group,while gauze strip was not used in the non-gauze strip group.The treatment conditions of the two groups were compared(operation time,postoperative exhaust time,times of lithotripsy by T-duct choledochoscopy,length of hospital stay).The intestinal barrier function(D-lactic acid,endotoxin)were compared between the two groups before and 3 days after operation.The rate of residual stone was compared between the two groups at 6 months after operation.Results The operative time,postoperative exhaust time and hospital stay of patients in the gauze strip group were shorter than those in the non-gauze strip group,and the number of lithotripsis by T-tube choledochoscope was less than that in the non-gauze strip group,the differences were statistically significant(P<0.05).At 3 days after operation,the levels of D-lactic acid and endotoxin in two groups were higher than those before operation,but the levels of D-lactic acid and endotoxin in gauze strip group were lower than those in non-gauze strip group,and the differences were statistically significant(P<0.05).The rate of residual stone in the gauze strip
作者
刘爱连
刘宇文
王建华
LIU Ailian;LIU Yuwen;WANG Jianhua(Department of General Surgery,Shangrao Central Hospital,Jiangxi Province,Shangrao334000,China;Department of General Surgery,Yanshan Yimo People's Hospital,Jiangxi Province,Yanshan334505,China)
出处
《中国当代医药》
CAS
2024年第22期59-62,67,共5页
China Modern Medicine
基金
江西省卫生健康委科技计划项目(202212771)。
关键词
自制纱布条
腹腔镜胆总管探查术
肝内胆管结石
残石率
术后恢复
Self-made gauze strip
Laparoscopic common bile duct exploration
Intrahepatic bile duct stone
Residual stone rate
Postoperative recovery
