【作者】 张勇；

【导师】 符国珍；

【作者基本信息】 中南大学 ， 外科学， 2010， 硕士

【摘要】 目的：了解腹腔镜联合胆道镜保胆手术前后胆囊收缩功能的变化。观察该手术对胆囊收缩功能的影响。分析保胆术后影响胆囊收缩功能的可能因素。方法：分析24例在中南大学湘雅医学院附属海口医院行腹腔镜联合胆道镜保胆手术治疗胆囊结石或胆囊息肉病患者的临床资料,通过B超测量术前和术后(1月至2年间)的胆囊收缩功能,使用SPSS13.0软件对测量数据进行统计分析。结果：(1)腹腔镜联合胆道镜保胆手术术后1个月与术前对比,胆囊收缩功能明显下降(P<0.05),但绝大多数患者胆囊收缩功能值仍在正常值范围内。(2)腹腔镜联合胆道镜保胆手术术后3个月与术前对比,胆囊收缩功能已无明显差异(P>0.05)。(3)腹腔镜联合胆道镜保胆手术术后6个月与术后1个月对比,胆囊收缩功能明显增强(P<0.05)。(4)腹腔镜联合胆道镜保胆手术术后6个月与术前对比,胆囊收缩功能已无明显差异(P>0.05),有恢复至术前水平的趋势。(5)腹腔镜联合胆道镜保胆手术术后6个月与术后1年、术后2年对比,胆囊收缩功能无明显差异(P>0.05),趋于平稳。(6)腹腔镜联合胆道镜保胆手术术后1个月、术后3个月、术后6个月分别与术前对比,空腹胆囊容积均明显下降(P<0.05)。(7)腹腔镜联合胆道镜保胆手术术后6个月与术后1个月对比,空腹胆囊容积有所上升(P<0.05),但仍明显低于术前水平(P<0.05)。(8)腹腔镜联合胆道镜保胆手术术后少数患者出现胆囊收缩功能不良,本组发生率为4.2%(1／24)。结论：(1)腹腔镜联合胆道镜保胆手术后1个月,胆囊收缩功能会有所下降,但绝大多数仍在正常值范围内,经过一段“恢复期”,胆囊收缩功能逐渐恢复到术前水平。(2)腹腔镜联合胆道镜保胆手术后,有可能发生胆囊收缩功能不良。多种因素可能对术后胆囊收缩功能产生影响。(3)腹腔镜联合胆道镜保胆手术后,空腹胆囊容积和胆囊收缩功能下降,可对消化功能产生不利影响。更多还原

【Abstract】 Objective:To understand the changes of gallbladder contractibility before and after the operation with laparoscope and choledochoscope for preservation of gallbladder. To observe the impact of the operation on gallbladder contractibility. To identity factors that may affect the contractibility of gallbladder after the operation.Methods:Conduct analysis of clinical data of 24 patients with cholecystolithiasis or gallbladder polyposis that were treated with the operation with laparoscope and choledochoscope for preservation of gallbladder surgery in the Central South University Xiangya Medical College,Haikou Hospital.Measure the level of gallbladder contractibility by B-ULTRASOUND preoperative and postoperative (one month to 2 years).Analyze measurement data and conduct statistical analysis using SPSS 13.0 software.Results:(1)The level of contractibility of gallbladder was significantly reduced 1 month after surgery (P<0.05),but for the vast majority of patients gallbladder contractibility is still within normal range.(2)The contractibility of gallbladder indicated no significantly difference 3 month after surgery vs.before surgery (P>0.05).(3)The contractibility of gallbladder enhanced significantly 6 month after surgery vs.1 month after surgery (P<0.05).(4)The contractibility of gallbladder indicated no significantly difference 6 month after surgery vs.before surgery (P>0.05),which has returned to the preoperative level trends.(5)The contractibility of gallbladder indicated no significantly difference 6 month after surgery vs.1-year & 2-year after surgery (P>0.05),become stable.(6)The fasting gallbladder volume(FGV) significantly reduced 1 month, 3 months and 6 months after surgery, compared with FGV before surgery (P<0.05).(7)The fasting gallbladder volume(FGV) increased 6 months after surgery, compared with FGV 1 month after surgery (P<0.05),but was still lower than the preoperative level (P<0.05). (8)A few patients had abnormal contractibility of gallbladder after the operation with laparoscope and choledochoscope for preservation of gallbladder.the occurrence rate for this group was 4.2%(1/24).Conclusions:(1)one month after the operation with laparoscope and choledochoscope for preservation of gallbladder, contractibility of gallbladder will decline, but most are still within the normal range.After a "recovery period",the contractibility of gallbladder gradually restores its function to the pre surgery level.(2)After the operation with laparoscope and choledochoscope for preservation of gallbladder, contractibility of gallbladder dysfunction may occur. A variety of factors may affect the contractibility of gallbladder after surgery.(3)After the operation with laparoscope and choledochoscope for preservation of gallbladder, fasting gallbladder volume (FGV) and the contractibility of gallbladder decreased and may have an adverse impact on the digestive function.更多还原