置胃管对腹腔镜胆囊切除术的影响因素探讨.DOCVIP

临床医学论文-置胃管对腹腔镜胆囊切除术的影响因素探讨 ??????????? 作者：徐晓跃 谭锦凤 李学明 李剑锋 【摘要】目的：探讨放置鼻胃管对腹腔镜胆囊切除术的影响因素。方法：２８７例接受ＬＣ手术的患者，随机分为置管组（n=１４４）和不置管组（n=１４３），对两组的手术持续时间、术后并发症和胃肠道功能的恢复时间、早期进食和下床活动时间、中转开腹率等方面进行比较分析。结果：统计结果显示，置胃管组和不置胃管组的手术时间、术后并发症、中转开腹率比较均无统计学差异；但不置胃管组术后３６h内进流质饮食者更多，补液时间在７２h内者更多，下床活动时间明显提前，与置胃管组相比具有显著统计学意义（P＜００１）。结论：ＬＣ手术前不常规放置鼻胃管是可行的。 ??? 【关键词】胃管；胆囊切除术，腹腔镜 ??? Influence of putting gastric canal on laparoscopic cholecystectomy? ??? 【Abstract】Objective: To observe the effect of putting gastric canal on Laparoscopic cholecystectomy. Methods: 287 patients receiving laparoscopic cholecystectomy were divided into two groups randomly, 144 patients of which were put a gastric canal before operation and the other 143 patients were not. After operation, some factors were compared between the two groups, which including the time of operation, the functional recovery time of gastrointestinal tract, the time of eating and moving on floor, and the rate of conversion to open surgery. Results: There are no significant differences between the two groups in operating time, the rate of complications and conversion to open surgery. But the patients without gastric canal moved and took food earlier, and the time of receiving fluid replacement was shorter than those who were put gastric canal before operation. Conclusions: It is not necessary to put gastric canal in rule before the operation of laparoscopic cholecystectomy. ??? 【Key words】Gastric canal;? Cholecystectomy,laparoscopic ??? 腹腔镜手术是２０世纪后期逐渐发展起来的一项新兴技术。２０世纪９０年代以来，发展迅速，现已广泛用于普通外科、妇产科和泌尿科的多种疾病的治疗。尤其是在普外科，腹腔镜胆囊切除术(LC)由于具有创伤小、痛苦少、恢复快等优点，已被证明是治疗良性胆囊疾病的金标准。２００３年１月至２００３年１２月，我院将２８７例接受ＬＣ手术的患者随机分为置胃管组和不置胃管组，对两组的手术时间、术后并发症和胃肠道功能的恢复时间、早期进食和下床活动时间、中转开腹率等方面进行比较分析，探讨ＬＣ手术前后放置鼻胃管的必要性与合理性。 ??? １资料与方法 ??? 1.1临床资料本组男９６例，女１９１例；２５～８４岁，平均４５６岁；病程３d～３０a，平均４３a。临床诊断：慢性结石性胆囊炎２１７例，慢性胆囊炎急性发作、胆囊颈结石嵌顿３４例，胆囊息肉６例，急性胆囊炎３０例。２６例既往有腹部手术史，其中１１例曾接受过鼻胃管。 ??? 1.２手术方法我们将２８７例患者随机分为两组：不置管组１４３例，置管组１４４例。两组均在术前１２h禁食，４h禁饮。置管组为对照组，ＬＣ前１h放置鼻胃管，术后行持续胃肠减压并保持通畅。拔管指征为肠鸣音恢复，无腹胀、呕吐，肛门恢复排气或排便。两组患