腹腔镜胆囊切除手术前后胆总管直径变化的临床意义

摘要

Objective To investigate the changes of common bile duct diameter before and after laparoscopic cholecystectomy. Methods 72 patients required cholecystectomy were involved in this clinical study. The patients were scheduled for laparoscopic cholecystectomy, and in the preoperative, postoperative 15～ 30d, 31～ 90d, 91～ 180d and 180～ 360d six periods, the diameter of common blie duct were measured and recorded by ultrasonography. Results 72 patients with preoperative common bile duct diameter was 5. 1～ 5. 4 mm, average of (5. 25±0. 6 ) mm; after 15～ 30d the diameter was (5. 3±0. 9 ) mm, while after 31～ 90d the diameter variation reaches a maximum value ( 6. 5±1. 5) mm, compared with preoperation is increased obviously, the difference was significant CP＜0. 05 ); after 91～ 180d the common bile duct diameter is smaller, the average is (6. 2±1. 3 ) mm, while after 181- 360d the common bile duct diameter is (5. 9±0. 8) mm, compared with preoperative difference is nonsignificant (P＞0. 05 ). Conclusion Perioperation of laparoscopic cholecystectomy, the common bile duct diameter is a dynamic process, usually after about 30 ～ 90d the common bile duct diameter appears increase phenomenon, and after about 180 - 360d the common bile duct diameter appears obvious retracting phenomena ( diameter size preoperatively with no difference ). If in the postoperative the common bile duct diameter of about 360d is not restored to normal value, is required for further examination, in order to eliminate the presence of extrahepatic biliary tract diseases caused by bile duct dilation phenomenon.%目的 观察腹腔镜胆囊切除手术(laparoscopic cholecystectomy,LC)前、后胆总管直径变化的临床意义.方法 选择72例择期行LC胆囊切除术患者作为观察对象,并在术前、术后15～30d、31～90d、91～180d、181～360d共6个时段使用超声测量并记录患者胆总管直径的大小,比较LC前、后不同时段胆总管的直径大小.结果 本组72例患者LC前的胆总管直径均在5.1～5.4 mm之间,平均(5.25±0.6)mm；术后15～30d患者的胆总管直径为(5.3±0.9)mm,术后31～90d为(6.5士1.5)mm,与术前相比有明显增大,差异有显著性(P＜0.05)；术后91～180d患者的胆总管直径则出现明显的缩小,直径为(6.2±1.3)mm；术后181～360d患者的胆总管直径为(5.9士0.8)mm,与术前比较差异无显著性(P＞0.05).结论 LC前、后胆总管直径大小的改变是一个动态过程,在术后31～90d左右胆总管直径代偿性的增加达到最大值,之后又逐渐缩小,在术后180～360d左右胆总管直径大小恢复至术前,而且在这个动态变化过程中胆总管直径始终在正常值范围内.若在术后360天左右胆总管直径未恢复至正常,则需行进一步检查,以此来排除是否存在胆道其它疾病而引起胆管扩张现象.