区域用药对胆总管结石取石术中术后胆道压力的影响

目的研究区域用药对胆总管结石取石术中Oddi括约肌的影响,来探讨区域用药对Oddi括约肌的保护作用。方法收集我院普外科2013年1月~2016年12月行开腹胆总管切开取石术的病例,随机分为去甲肾上腺素组(N组)、阿托品组(A组)、生理盐水对照组(C组),术中经胆道镜测压,记录每组用药前后Oddi括约肌基础压(SOBP),胆总管内压(CBDP)。术后3 d每天区域用药后再测量胆道压力并记录。结果共97例患者纳入本研究,通过配对t检验、单因素方差分析和Tukey-Kramer法分析,结果显示N组和A组用药前后SOBP差异有统计学意义(P0.05)。三组之间SOBP差值比较差异有统计学意义(P0.05),N组与C组之间、A组与C组之间用药后5 min的SOBP差值的差异有统计学意义(P=0.000),而两组之间的SOBP差值的差异无统计学意义(P=0.290)。术后胆道压力的测定提示,N组和A组胆道压力低于对照组(P0.05),差异无统计学意义(P0.05)。结论经胆总管灌洗阿托品或去甲肾上腺素能有效降低胆总管结石取石术中SO的压力,也能降低术后胆道压力。

Effect of regional drug on biliary pressure during the surgery and after the surgery of choledocholithotomy

Objective To study the effect of regional drug on Oddi sphincter during the surgery of choledocholithotomy, and to explore the protective effect of regional drug on Oddi sphincter. Methods The cases of open cholecystectomy in the department of general surgery from January 2013 to December 2016 were selected and randomly divided into norepinephrine group(group N), atropine group (group A) and saline control group (group C). The pressure during the surgery was measured by cholangioscopy. The Oddi sphincter basal pressure (SOBP) and common bile duct pressure (CBDP) before and after using drugs in each group were recorded. Bile duct pressure was measured and recorded daily after 3 days of surgery. Results A total of 97 patients were enrolled in this study. The paired t-test, one-way ANOVA and Tukey-Kramer analysis were used. The results showed that there was significant difference in SOBP between N group and A group before and after treatment, (P<0.05). The difference of SOBP among the three groups was statistically significant (P<0.05). There was significant difference in SOBP between N group and C group and between group A and group C at 5 min after treatment(P=0.000).While the difference of SOBP between the two groups was not statistically significant (P=0.290). The postoperative biliary pressure showed that the biliary pressure was lower in group N and group A than that in control group (P<0.05), but there was no significant difference in pressure between the two groups (P>0.05). Conclusion Atropine or norepinephrine lavage via common bile duct can effectively reduce the pressure of SO in choledocholithotomy and reduce the postoperative biliary pressure.