天津医药

天津医药 ›› 2018, Vol. 46 ›› Issue (7): 720-723.doi: 10.11958/20180331

• 诊断技术 • 上一篇    下一篇

腹腔镜胆总管探查一期缝合术后患者肝功能变化的 前瞻性观察及分析

刘浩 1，尚海涛 2，张西波 2，鲍建亨 2，郝成飞 2，刘军舰 2，李忠廉 2△   

  1. 1天津医科大学（邮编300070）；2天津市南开医院肝胆胰第二外科
  • 收稿日期:2018-03-06 修回日期:2018-05-04 出版日期:2018-07-15 发布日期:2018-07-15
  • 通讯作者: 李忠廉 E-mail:nkyylzl@163.com
  • 作者简介:刘浩（1991），男，硕士在读，主要从事肝胆胰外科的基础与临床研究
  • 基金资助:
    基于内质网应激的清热利湿法防治阻塞性黄疸肝损伤的分子机制研究

A prospective observation and analysis of changes in liver function after primary closure following laparoscopic common bile duct exploration

LIU Hao1, SHANG Hai-tao2, ZHANG Xi-bo2, BAO Jian-heng2, HAO Cheng-fei2, LIU Jun-jian2, LI Zhong-lian2△   

  1. LIU Hao1, SHANG Hai-tao2, ZHANG Xi-bo2, BAO Jian-heng2, HAO Cheng-fei2, LIU Jun-jian2, LI Zhong-lian2△
  • Received:2018-03-06 Revised:2018-05-04 Published:2018-07-15 Online:2018-07-15

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摘要： 目的 观察继发性胆总管结石患者行腹腔镜胆总管探查一期缝合术后肝功能的变化规律，评价其安全 性。方法 符合手术适应证的继发性胆总管结石患者210例，随机数字表法分为一期缝合组（110例）和T管引流组 （100例）。记录2组患者手术前及术后第1、3天血清总胆红素（TBIL）、直接胆红素（DBIL）、总胆汁酸（TBA）、丙氨酸 转氨酶（ALT）、碱性磷酸酶（ALP）、γ-谷氨酰转肽酶（GGT）水平并进行组内及组间比较。结果 2组患者术后TBIL、 DBIL、ALT、ALP、GGT、TBA均较术前下降（P＜0.05）；术后1 d时2组均有部分患者TBIL较术前升高（P＜0.05）；T管 引流组胆红素下降幅度较一期缝合组更大，差异有统计学意义（P＜0.05）；一期缝合组术后胆红素升高患者血清胆红 素水平于术后3 d低于术前水平。结论 满足适应证的继发性胆总管结石患者建议行腹腔镜胆总管探查并一期缝 合术，术后肝功能的变化在安全范围内。

关键词: 胆总管结石, 缝合技术, 引流术, 肝功能试验, 一期缝合, T管引流

Abstract: Objective To observe the change of liver function after laparoscopic common bile duct exploration in patients with secondary common bile duct stones, and evaluate its safety. Methods A total of 210 patients with secondary common bile duct stones conforming to operative indications were divided into a suture group (n=110) and T tube drainage group (n=100) with random number table method. The values of serum total bilirubin (TBIL), direct bilirubin (DBIL), total bile acid (TBA), alanine aminotransferase (ALT), alkaline phosphatase (ALP) and transglutaminase (GGT) were detected preoperation and 1 day, 2 days after operation, and compared between groups. Results The levels of TBIL, DBIL, ALT, ALP, GGT and TBA were significantly lower after operation than those before operation in the two groups (P＜0.05). Some patients showed higher levels of TBIL 1 day after operation than that pre-operation in both of the two groups (P＜0.05). The level of jaundice decreased rapidly in the T tube drainage group than that in the primary closure group (P＜0.05). In the primary closure group, the serum level of bilirubin in patients with elevated bilirubin was lower on the third day after operation than that before operation. Conclusion Patients with secondary common bile duct stones conforming to operative indications are suggested primary closure following laparoscopic common bile duct exploration, and changes of liver function after operation are in the safe range.

Key words: choledocholithiasis, suture techniques, drainage, liver function tests, primary closure, T-tube drainage