摘要
目的:对术后胆道镜检查应用5%甘露醇与生理盐水作为冲洗液进行随机对照研究,分别观察两种冲洗液对肝功能的影响并比较两者是否存在差异,为胆道镜检查冲洗液的选择提供依据,并且为以后的胆道镜下电操作冲洗液的筛选打下基础。
方法:
病例选择:
入组条件:选择2005.3—2005.9月间,胆管探查术后留置T管4周以上病人。
排除条件:1.检查前肝功能指标有明显异常。2.胆道镜操作时间超过2小时/冲洗液用量超过3000ml。3.有明确慢性肝、肾疾病。有上述任何一项者则不能入组。
分组方法:
先将合乎病例选择条件的30例病人,按检查的先后顺序编号,每人一号,开始者为1,最后者为30。将30个数字按随机排列表随机排序;然后将与随机排列表末位为奇数对应编号的病人分在生理盐水组,而与偶数位上对应编号的病人分在5%甘露醇组
操作方法:
病人于检查日晨禁食,检查前2小时口服抗生素,检查时取仰卧位,常规进行心电监测建立静脉通道并给予液体补充。先行拔除T管,局部应
Background: The effect of choledochoscopy is well known to us, and choledochoscopy is applied in hepatic biliary surgery widely. But there are little reports on research of irrigation of choledochoscopy.Objective: To investigate which irrigation has a greater effect on hepatic function, NS or 5%mannitol? In order to provide scientific basis for selecting irrigation of choledochochoscopy.Methods: select 30 cases who underwent the bile duct exploration because of biliary stones and over 4 weeks after operations, and have normal hepatic function before choledochoscopy. Exclusion criteria: any cases who has chronic liver disease and heart or kidney disease, and the case who is checked over 2 hours or applied irrigation over 3000ml. 30 cases were selected by the criteria, and 15 cases were applied NS as irrigation, the other 15 cases were applied 5%mannitol. Choledochoscopies were preformed by same surgeon, applying the same 4mm Olympus XP20 TV-fibro-choledochoscopy, and kept same height from the lowest level of 3L bag to median axillary's line. The peripheral venous blood was sampled in the early
morning before choledochoscopy, and at the first day, the third day and the fifth day after choledochoscopy to determine serum ALT, AST, ALP, TBIL, DBIL and other blood indexes.Results: There were no significant differences of age structure and peri-choledochoscopy hepatic function, the consuming volume of irrigation, the wasting time of choledochoscopy between NS and 5%mannitol group. There were no significant changes of serum ALT, AST, ALP, TBIL, DBIL and HCT between pre-choledochoscopy and Id, 3d after choledochoscopy in NS group, and in 5%mannitol group. There were no significant differences of serum ALT, AST, ALP, TBIL, DBIL at the first day, the third day after choledochoscopy between two groups.Conclusion: (1) Both NS and 5%mannitol have no significant effects on hepatic function;they all can be applied as irrigation in choledochoscopy. (2) 5%mannitol can be applied widely in choledochoscopy as a new and nonelectrolyte irrigation.
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