T管测压对腹腔镜胆道手术T管引流术后拔管的指导意义

摘要

Objective To define the etiology of abdominal symptoms before extubation by using T-tube measurement of intraluminal pressure of biliary tract, and to investigate the guiding significance of T-tube manometry to the extubation.Methods Of the 94 cases of choledocholithotomy with T-tube drainage during January 2013 to January 2014, 32 cases experienced a variety of symptoms (Symptom Group) and 62 cases had no symptom (Control Group).Both groups were given manometry of biliary tract to compare the billiary pressure through central venous pressure apparatus.Results The billiary pressure in Symptom Group was (19.85±3.89) cm H2O, which was significantly higher than Control Group staying at (10.47±3.90) cm H2O (t=11.055, P=0.000).Conclusions Manometry of biliary tract has guiding significance to the T-tube drainage operation of choledocholithotomy under laparoscope.Patients with symptoms before extubation should be conducted manometry of biliary tract.If the pressure is higher than normal, the choledochoscopy should be conducted positively to further figure out the presence of cholelithiasis.Patients with excessive pressure but no obvious symptom should be given choledochoscope examination positively to prevent misdiagnosis.%目的 通过T管对胆道内压力测定,明确拔管前腹部症状的病因,并探讨T管测压对胆道手术T管引流术后拔管的指导意义. 方法 2013年1月~2014年1月,94例胆总管切开取石T管引流术后患者中,存在右上腹各种不适症状32例(症状组),无症状62例(对照组),均通过中心静脉压装置行胆道测压,比较2组胆道压力. 结果 症状组32例胆道压力(19.85±3.89)cm H2O,明显高于无症状的对照组[(10.47±3.90)cm H2O,t=11.055,P=0.000]. 结论 胆道测压对于腹腔镜下胆总管切开取石T管引流术后拔管有指导意义.对于那些拔管前存在症状的病人,应用胆道测压,压力值高于正常值,可积极行胆道镜检查,进一步明确有无结石.对于经过测压,压力值过高而无明显症状者,应积极行胆道镜进一步检查,防止漏诊.