腹腔镜术后氧气置换二氧化碳气腹对胆道探查取石术后腹腔厌氧菌感染的影响

发布时间：2018-09-18 16:39

【摘要】：目的:为了解腹腔镜术后氧气置换二氧化碳气腹,从而提供腹腔内局部高氧环境对胆总管结石伴急性胆管炎并行胆总管探查取石术患者术后腹腔厌氧菌感染的影响,并初步探讨其意义。方法:选取2015年6月至2016年12月到遵义医学院附属成都市第二人民医院肝胆外科就诊的胆总管结石伴急性胆管炎患者共68例随机分为两组,其中对照组34例,实验组34例。对照组采用腹腔镜下胆囊切除+胆总管探查取石+T管引流术(LC+LCBDE+TD),术后予以二氧化碳三次置换腹腔内二氧化碳;实验组采用腹腔镜下胆囊切除+胆总管探查取石+T管引流术,术后予以氧气三次置换出患者腹腔内残余二氧化碳,使患者腹腔内保持局部高浓度氧气状态结束手术。记录所有患者的术前一般情况:性别、年龄,术前感染指标:白细胞计数(White blood cell count,WBC)、降钙素原(Procalcitonin,PCT)、C反应蛋白(C-reactive protein,CRP),术前肝功能指标:丙氨酸转氨酶(Alanine aminotransferase,ALT)、天门冬氨酸氨基转移酶(Aspartate tr ansaminase,AST)、总胆红素(Total bilirubin,TBIL)、直接胆红素(Conjugated bilirubi n,DBIL)。记录两组患者胆管内胆汁厌氧菌培养的阴性及阳性、术后1、3天经T管引出胆汁厌氧菌培养的阴性及阳性以及术后1、3天腹腔引流管引出的腹腔引流液行厌氧菌培养的阴性及阳性结果。记录术后1、3天的感染指标(WBC、PCT、CRP)以及肝功能指标(ALT、AST、TBIL、DBIL)。并将以上数据进行统计学分析。结果:1.对照组及实验组的性别及年龄比较无统计学差异(P0.05)。2.对照组以及实验组的各项肝功能指标(ALT、AST、TBIL、DBIL)在术前、术前与术后1天之差、术后1天与术后3天之差以及术前与术后3天之差比较,差异无统计学意义(P0.05)。3.对照组以及实验组在术前WBC以及术前与术后1天、术后1天与术后3天、术前与术后3天的WBC差值比较无统计学差异(P0.05)。4.对照组以及实验组术前PCT比较无统计学差异(P0.05);对照组以及实验组在术前与术后1天、术后1天术后3天、术前与术后3天PCT的差值比较差异有统计学差异(P0.05),并且实验组的降钙素原在术后1天及术后3天内的下降程度较对照组多。5.对照组以及实验组的CRP在术前、术前与术后1天之差比较无统计学差异(P0.05)。对照组以及实验组在术后1天与术后3天、术前与术后3天的CRP的差值比较差异有统计学意义(P0.05),并且实验组的C反应蛋白下降程度较对照组多。6.对照组与实验组在术中取胆汁行厌氧菌培养的结果比较无统计学差异(P0.05),术后1天及术后3天取T管中胆汁行厌氧菌培养的结果比较无统计学差异(P0.05),术后1天及术后3天取腹腔引流管中引流液行厌氧菌培养的结果比较差异有统计学意义(P0.05),并且实验组的阳性率较对照组明显降低。结论:1.二氧化碳气腹后予以氧气置换,提供腹腔内局部高氧环境,可以使腹腔引流液厌氧菌培养的阳性率降低。2.氧气作为安全的膨腹气体,在腹腔镜术后置换出腹腔内的二氧化碳后,可以使得患者术后的炎症指标降低。3.在胆管结石术后的感染情况评估中,降钙素原较白细胞计数及C反应蛋白敏感。
[Abstract]:Objective: To investigate the effect of local hyperoxia on anaerobic bacterial infection in the abdominal cavity of patients with choledocholithiasis complicated with acute cholangitis and choledocholithotomy after laparoscopic choledocholithotomy by oxygen replacement of carbon dioxide pneumoperitoneum. Sixty-eight patients with choledocholithiasis complicated with acute cholangitis were randomly divided into two groups: control group (34 cases) and experimental group (34 cases). Laparoscopic cholecystectomy+common bile duct exploration+T-tube drainage was used in the experimental group,and oxygen was used to replace the residual carbon dioxide in the abdominal cavity three times after operation to keep the local high concentration of oxygen in the abdominal cavity. Blood cell count (WBC), procalcitonin (PCT), C-reactive protein (CRP), preoperative liver function indicators: Alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubi n (TBIL), direct bilirubi n (Conjugated bilirubi n, TBIL) The negative and positive results of anaerobic culture of bile duct in the two groups were recorded. The negative and positive results of anaerobic culture of bile duct in the two groups were recorded 1 and 3 days after operation, and the negative and positive results of anaerobic culture of abdominal drainage fluid in the abdominal drainage tube at 1 and 3 days after operation. The infection index (WBC, PCT, CRP) and liver function at 1 and 3 days after operation were recorded. Indicators (ALT, AST, TBIL, DBIL). And the above data were statistically analyzed. Results: 1. There was no significant difference in sex and age between the control group and the experimental group (P There was no significant difference in WBC between the control group and the experimental group (P 0.05). 3. There was no significant difference in WBC between the control group and the experimental group (P 0.05). There was no significant difference in PCT between the control group and the experimental group (P 0.05). There was significant difference in PCT between preoperative and postoperative day 1, postoperative day 3, preoperative and postoperative day 3 (P 0.05), and the decrease of procalcitonin in experimental group was more than that in control group. 5. There was no significant difference in CRP between preoperative and postoperative day 1 (P 0.05). The difference of CRP between the control group and the experimental group was statistically significant (P 0.05), and the decrease of CRP in the experimental group was more than that in the control group. There was no significant difference in the results of anaerobic culture of bile from T-tube on the third day after operation (P 0.05). There was significant difference in the results of anaerobic culture of bile from abdominal drainage tube on the first day after operation and on the third day after operation (P 0.05). The positive rate of experimental group was significantly lower than that of control group. Conclusion: 1. The positive rate of anaerobic bacteria culture in abdominal drainage fluid can be reduced by providing local hyperoxic environment in abdominal cavity. 2. Oxygen, as a safe gas for abdominal distention, can reduce the inflammatory index after laparoscopic operation. 3. Procalcitonin is whiter in the evaluation of infection after cholelithiasis operation. Cell counts and C reactive protein were sensitive.
【学位授予单位】：遵义医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R657.42

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