Application of low-dose dexamethasone during perioperative period of laparoscopic transcystic common bile duct exploration

doi:10.3877/cma.j.issn.2095-3232.2024.03.014

Abstract

Abstract:

Objective

To evaluate the efficacy and effect of low-dose dexamethasone during perioperative period of laparoscopic transcystic common bile duct exploration (LTCBDE).

Methods

Clinical data of 97 patients with cholecystolithiasis complicated with choledocholithiasis who underwent LTCBDE in Renmin Hospital of Wuhan University from January 2021 to April 2022 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 44 patients were male and 53 female, aged from 17 to 86 years, with a median age of 54 years. All patients received magnetic resonance cholangiopancreatography (MRCP) before surgery. All patients were divided into the dexamethasone (n=40) and control groups (n=57) according to whether low-dose dexamethasone was used during perioperative period. In the dexamethasone group, 10 mgintravenous dose of dexamethasone was given before anesthesia induction and at postoperative 2 day, whereas dexamethasone or equivalent glucocorticoid drugs (hormones) were not used in the control group. Perioperative outcomes of all patients were observed. The WBC liver function and visual analogue scale (VAS) score were compared by t test between two groups. The incidence of postoperative nausea and vomiting (PONV) and bile leakage was compared by Chi-square test.

Results

LTCBDE was successfully performed in two groups. No death or other serious complications were reported during perioperative period. The average WBC, ALT, AST, TB, DB and VAS score in the dexamethasone group were (8.8±2.4)×10⁹/L, (58±9) U/L, (57±10) U/L, (41.4±6.4) μmol/L, (25.8±3.5)μmol/L and 2.3±0.9, significantly lower than (10.0±2.1)×10⁹/L, (55±10) U/L, (44±7) U/L, (43.0±5.3) μmol/L, (27.0±2.1) μmol/Land 3.9±0.5 in the control group (t=-2.61, -1.87, -6.27, -6.72, -2.08, -8.19; P<0.05). The incidence of PONV in the dexamethasone group was 18%(7/40), significantly lower than 37%(21/57) in the control group (χ²=4.28, P<0.05). 3 and 6 patients developed bile leakage in two groups, and there was no significant difference in the incidence rate (χ²=0.26, P>0.05).

Conclusions

Perioperative administration of low-dose dexamethasone controbutes to reducing the incidence of postoperative pain and PONV of LTCBDE, improving postoperative liver function and mitigating postoperative inflammatory response without increasing the incidence of complications.

Key words: Dexamethasone, Laparoscopic transcystic common bile duct exploration, Perioperative period, Postoperative complications

Lei Zhu, Bin Wang, Aimin Zhang, Xiaoyan Chen, Yanbing Zhang, Haolong Qi. Application of low-dose dexamethasone during perioperative period of laparoscopic transcystic common bile duct exploration[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2024, 13(03): 339-343.

/ / Recommend

Add to citation manager EndNote|Ris|BibTeX

URL: https://zhgzwkssxdzzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.2095-3232.2024.03.014

https://zhgzwkssxdzzz.cma-cmc.com.cn/EN/Y2024/V13/I03/339

Figures/Tables 4

References 21

[1]	王启晗，张中文，吴健, 等. 上海地区胆囊结石病的流行病学调查[J]. 外科理论与实践, 2018, 23(3):252-257.
[2]	韩明明，张宝，杨壮杰, 等. 继发性肝外胆管结石患者腹腔镜下经胆囊管胆总管探查取石术的疗效[J]. 实用医学杂志, 2016, 32(12):1991-1993.
[3]	冯秋实. 胆总管结石的微创治疗[J]. 外科理论与实践, 2022, 27(3):185-188.
[4]	Lei YT, Xu B, Xie XW, et al. The efficacy and safety of two low-dose peri-operative dexamethasone on pain and recovery following total hip arthroplasty: a randomized controlled trial[J]. Int Orthop, 2018, 42(3):499-505.
[5]	Gan TJ, Belani KG, Bergese S, et al. Fourth consensus guidelines for the management of postoperative nausea and vomiting[J]. Anesth Analg, 2020, 131(2):411-448.
[6]	Pan L, Chen M, Ji L, et al. The safety and efficacy of laparoscopic common bile duct exploration combined with cholecystectomy for the management of cholecysto-choledocholithiasis: an up-to-date meta-analysis[J]. Ann Surg, 2018, 268(2):247-253.
[7]	赵亮，蒋超，孙大伟, 等. 微创治疗非扩张性肝外胆管结石230例临床分析[J]. 中华普通外科杂志, 2020, 35(7):521-523.
[8]	Bisgaard T, Klarskov B, Kehlet H, et al. Preoperative dexamethasone improves surgical outcome after laparoscopic cholecystectomy: a randomized double-blind placebo-controlled trial[J]. Ann Surg, 2003, 238(5):651-660.
[9]	Myles PS, Corcoran T. Benefits and risks of dexamethasone in noncardiac surgery[J]. Anesthesiology, 2021, 135(5):895-903.
[10]	董伟，刘家鹏，韩建阁. 地塞米松在围手术期的应用进展[J]. 医疗装备, 2022, 35(15):186-189.
[11]	廖永晖，钟鼎文，何勇, 等. 地塞米松联合肝切除术对原发性肝癌患者术后血清炎症介质及肝功能的影响[J]. 中国药物经济学, 2019, 14(12):86-88.
[12]	曾筱怡，李洁，李玲, 等. 小剂量地塞米松对原发性肝癌患者肝动脉化疗栓塞术后肝功能恢复的影响[J]. 临床合理用药杂志, 2022, 15(24):90-93.
[13]	赵丹，牛焕，于婷婷, 等. 地塞米松　醋酸泼尼松片联合还原型谷胱甘肽治疗高胆红素血症合并急性药物性肝损伤的疗效评价[J]. 中国药物与临床, 2022, 22(3):252-254.
[14]	Zhang JM, An J. Cytokines, inflammation, and pain[J]. Int Anesthesiol Clin, 2007, 45(2):27-37.
[15]	Peng C, Li C, Yuan B, et al. The efficacy of dexamethasone on pain management for knee arthroscopy: a meta-analysis of randomized controlled trials[J]. Medicine, 2020, 99(16):e19417.
[16]	Lex JR, Edwards TC, Packer TW, et al. Perioperative systemic dexamethasone reduces length of stay in total joint arthroplasty: a systematic review and meta-analysis of randomized controlled trials[J]. J Arthroplasty, 2021, 36(3):1168-1186.
[17]	陈栋，曾朝阳，任燕, 等. 地塞米松复合罗哌卡因超声引导下腹横肌平面阻滞在腹腔镜胆囊切除术后的镇痛效果[J]. 中国实用医药, 2021, 16(22):116-118.
[18]	于洋，孙建良. 术后恶心呕吐(PONV)的机制及其防治研究进展[J]. 麻醉安全与质控, 2018, 2(2):113-118.
[19]	Horn CC, Wallisch WJ, Homanics GE, et al. Pathophysiological and neurochemical mechanisms of postoperative nausea and vomiting[J]. Eur J Pharmacol, 2014, 722: 55-66.
[20]	孔令荣. 托烷司琼联合小剂量地塞米松对LC患者术后呕吐等并发症的影响[J]. 现代医药卫生, 2016, 32(8):1229-1230.
[21]	Diakos EA, Gallos ID, El-Shunnar S, et al. Dexamethasone reduces pain, vomiting and overall complications following tonsillectomy in adults: a systematic review and meta-analysis of randomised controlled trials[J]. Clin Otolaryngol, 2011, 36(6):531-542.

组别	例数	性别（例）		年龄（岁，±s）	ALT （U/L，±s）	AST （U/L，±s）	TB （μmol/L，±s）	DB （μmol/L，±s）	WBC （×10⁹/L，±s）	糖尿病（例）
组别	例数	男	女	年龄（岁，±s）	ALT （U/L，±s）	AST （U/L，±s）	TB （μmol/L，±s）	DB （μmol/L，±s）	WBC （×10⁹/L，±s）	糖尿病（例）
地塞米松组	40	15	29	54±16	199±54	142±68	78.9±21.3	59.6±24.7	7.8±2.5	8
对照组	57	25	28	53±16	187±61	153±63	75.3±18.9	54.0±19.2	7.5±2.3	7
统计值		χ²=1.70		t=0.21	t=0.99	t=-0.82	t=0.88	t=1.26	t=0.61	χ²=1.07
P值		0.19		0.92	0.41	0.65	0.82	0.36	0.57	0.30

组别	例数	性别（例）		年龄（岁，±s）	ALT （U/L，±s）	AST （U/L，±s）	TB （μmol/L，±s）	DB （μmol/L，±s）	WBC （×10⁹/L，±s）	糖尿病（例）
组别	例数	男	女	年龄（岁，±s）	ALT （U/L，±s）	AST （U/L，±s）	TB （μmol/L，±s）	DB （μmol/L，±s）	WBC （×10⁹/L，±s）	糖尿病（例）
地塞米松组	40	15	29	54±16	199±54	142±68	78.9±21.3	59.6±24.7	7.8±2.5	8
对照组	57	25	28	53±16	187±61	153±63	75.3±18.9	54.0±19.2	7.5±2.3	7
统计值		χ²=1.70		t=0.21	t=0.99	t=-0.82	t=0.88	t=1.26	t=0.61	χ²=1.07
P值		0.19		0.92	0.41	0.65	0.82	0.36	0.57	0.30

组别	例数	手术时间（min）	术中出血量（ml）	结石最大直径（cm）
地塞米松组	40	98±10	88±11	1.2±0.3
对照组	57	98±11	88±12	1.3±0.2
t值		-0.22	-0.31	-1.79
P值		0.75	0.76	0.08

组别	例数	手术时间（min）	术中出血量（ml）	结石最大直径（cm）
地塞米松组	40	98±10	88±11	1.2±0.3
对照组	57	98±11	88±12	1.3±0.2
t值		-0.22	-0.31	-1.79
P值		0.75	0.76	0.08

组别	例数	ALT （U/L）	AST （U/L）	TB（μmol/L）	DB（μmol/L）	WBC（×10⁹/L）
地塞米松组	40	55±10	44±74	41±6	25.8±3.5	8.8±2.4
对照组	57	58±9	57±10	43±5	27.0±2.1	10.0±2.1
t值		-1.87	-6.27	-6.72	-2.08	-2.61
P值		0.04	0.03	0.02	0.02	0.01

Please choose a citation manager

Content to export