超声刀与高频电刀在腹腔镜胆道探查术中的对比研究

目的:对比研究超声刀(ultrasonic harmonic scalpel,UHS)与高频电刀(high-frequency mono-polar electronic scalpel,HMES)在腹腔镜胆道探查术(laparoscopic common bile duct exploration,LCBDE)中的应用价值.方法:回顾分析216例LCBDE患者的临床资料,其中98例术中应用UHS(A组),118例术中应用HMES(B组);对比分析两组手术时间、术中出血量、中转开腹率、术后胆漏率、术后出血量及住院时间;检测两组患者术前及术后第1天、第3天、第5天ALT、AST、TBIL、DBIL、GGT、ALP水平.结果:两组患者手术时间、术中出血量、中转开腹率、术后胆漏率、术后出血量及住院时间差异均无统计学意义(P＞0.05);肝功能检测显示,与术前比较,A组术后第1天,B组术后第1天、第3天ALT、AST明显升高(P＜0.05),第5天两组均恢复至正常水平;术后第3天两组间差异有统计学意义(P＜0.05).两组患者术后第3天、第5天TBIL、DBIL水平较术前及术后第1天显著降低,术后第5天较第3天显著下降(P＜0.05);术后第5天两组ALP、GGT较术前显著下降,两组间相比差异无统计学意义(P＞0.05).结论:LCBDE术中应用UHS、HMES均是安全、有效的,可有效解除胆道梗阻.

Comparative study of the application of ultrasonic harmonic scalpel or high-frequency mono-polar electronic scalpel in laparoscopic common bile duct exploration

Objective: To study the the application of ultrasonic harmonic scalpel or high-frequency mono-polar electronic scalpel in l laparoscopic common bile duct exploration.Methods: Two hundred and sixteen patients were divided into UHS(A) group(n = 98) and HMES(B) group(n = 118).Operation status such as conversion rate,average operation time,bleeding,bile leakage and length of stay were compared.Liver function tests such as ALT,AST,TBIL,DBIL,GGT and ALP were performed before operation and 1,3,5 day after operation.Results: The operation status between 2 groups is similar.The postoperative level of ALT and AST elevated significantly 1 d in group A and 1 d,3 d in group B compared to that of the preoperative value(P < 0.05).However,ALT and AST decreased to normal level on 5 d after operation and there was a significance on 3 d between two groups(P < 0.05).While the postoperative level of TBIL and DBIL decreased significantly 3 d,5 d in two groups compared to that of the preoperative value and 1 d after operation(P < 0.05).We also found significant difference with TBIL and DBIL on 5 d compared with that of 3 d value after operation.For ALP and GGT,the level of them decreased significantly on 5 d after operation compared with the preoperative statue.There was no significant difference between two groups in all postoperative items.Conclusions: The application of UHS and HMES in LCBDE is safe and effective.