胆总管压力监测确定胆总管探查术后T型管夹管时机探讨

目的探讨根据胆总管压力确定胆总管探查术后T型管夹管时机的可行性。方法择期行胆总管探查的40例患者采取信封抽签法随机分为对照组和试验组各20例，对照组采取常规的方法夹闭T型管，即术后患者无发热，胆汁转为澄清，酌情夹闭T型管，先于进食前后夹管2h，逐渐增至白天夹管夜间开放，如患者无不适转为全日夹管。试验组根据术后胆总管压力监测结果确定夹管，即当胆总管压力小于2．1kPa（21cmH2O）时夹闭T型管。比较两组患者术后第1天、第3天、第7天经T型管监测胆总管压力，胆管流量及流量阻力，比较两组术后72h胆汁引流量，比较两组患者开始夹管时间及闭管时间。结果两组术后第1天胆管流量、胆管流量阻力、胆总管压力比较差异无统计学意义（P〉0．05）；试验组术后第3天、第7天胆管流量阻力、胆总管压力均较对照组明显降低（P〈0．05），胆管流量较对照组明显增加（P〈0．05）；试验组术后72h胆汁引流量较对照组明显减少（P〈0．05）；试验组夹管和闭管时间均较对照组明显提前（P〈0．05）。结论胆总管探查术后根据胆总管压力确定T型管夹管时机可以促进胆道功能尽快恢复，可使T型管的夹管和闭管时间明显提前，促进患者术后康复。

The Right Time for Clipping T Tube Depending on Bile Duct Pressures in Patients with Common Bile Duct Exploration

Objective To investigate the right time for dipping T tube depending on bile duct pressure in patients with common bile duct exploration. Methods 40 patients with common bile duct exploration were equally divided into control group and experimental group randomly. The T tubes in the control group were closed in a routine way： e.g. The T tubes were closed depending on no fever and appearance of clear bile, first closed for 2 hours before and after meals, then dosed at daytime and opened at nighttime, and finally closed all day and night if they showed no unfitness. In the experimental group, the tubes were dosed was depended on the common bile duct pressure. The tubes were clipped and dosed when the pressure was lower than 2.1 kPa（21 cmH2O）. The common duct pressures, flows and flow resistances monitored via T tubes on the first, third and seventh days were compared between the two groups. Besides, biliary drainage volume 72 hours after operation as well as durations for dosing tubes were compared between the groups. Results On the first day, no significant differences were found between the groups in common duct pressures, flows and flow resistances （P〉0.05）, but the common duct pressures and flow resistances were significantly lowered, and the flows were significantly enhanced in the experiment, compared to the controls （P〈0.05） on the third and seventh days. At hour 72 after operation, the biliary drainage volume and transfusion volume were both increased significantly compared to the controls （P〈0.05）. The durations for clipping and closing the T tubes were significantly shortened （P〈0.05）. Conclusion The confirmation of right time for clipping T tube after common bile duct exploration plays an active role in promoting the soon recovery of biliary function, shorten the duration of clipping and closing the tubes, thus promoting the postoperative rehabilitation of the patients.