摘要
目的探讨胆道术后胆漏的危险因素及经T管旁置管引流治疗的效果。方法选取2015年12月~2018年12月我院普外科开展胆道手术后出现胆漏的18例患者,根据胆漏发生原因和情况进行针对性治疗,分为手术治疗和保守治疗,手术治疗患者列为对照组,非手术治疗列为观察组,比较2组患者治疗后的有效性、围术期指标以及并发症发生率。结果经探查18例患者中,有33.33%患者由于传统胆总管手术失误导致胆漏,22.22%患者由于LC术致使胆漏,16.67%患者由于腹腔镜胆总管结石术所致,肝脏外伤切除术与胰十二指肠切除术均为11.11%,肝癌术后导致胆漏占5.56%。非手术治疗的总有效率高达100%,手术治疗有效率为81.82%,无显著差异性(P>0.05)。观察组的胆漏消失时间与住院时间均少于对照组(P<0.05);两组胆汁引流量相当(P>0.05)。非手术治疗无并发症产生,手术治疗的并发症发生率为45.45%,并发症差异具有显著性(P<0.05)。结论肝胆外科手术失误是导致胆漏的主要危险因素,早期发现胆漏,予经T管旁置管负压持续引流,能有效治愈胆漏症状,避免患者再手术治疗,降低并发症的产生,可有效降低对患者的损伤以及降低患者手术费用。
Objective To investigate the risk factors of bile leakage after biliary tract and the effect of T-tube drainage.Methods Eighteen patients with bile leakage after biliary tract surgery in our hospital from December 2015 to December 2018 were selected.According to the causes and conditions of bile leakage,targeted treatment was divided into surgical treatment and conservative treatment.The patients were classified as the control group,and the non-surgical treatment was classified as the observation group.The effectiveness,perioperative index and complication rate of the two groups were compared.Results Of the 18 patients,33.33%had bile leakage due to traditional choledochal surgery errors,22.22%had bile leakage due to LC,and 16.67%were due to laparoscopic common bile duct stones.Liver trauma resection and Pancreaticoduodenectomy was 11.11%,and bile leakage accounted for 5.56%after liver cancer surgery.The total effective rate of non-surgical treatment was as high as 100%,and the effective rate of surgical treatment was 81.82%.There was no significant difference(P>0.05).The time of disappearance of bile leakage and hospitalization time in the observation group were less than that in the control group(P<0.05);the bile drainage in the two groups was equivalent(P>0.05).Non-surgical treatment showed no complications.The complication rate of surgical treatment was 45.45%,and the difference of complications was significant(P<0.05).Conclusion Hepatobiliary surgery errors are the main risk factors for bile leakage.Early detection of bile leakage and continuous drainage through T-tube bypass negative pressure can effectively cure bile leakage symptoms,avoid patients’reoperation and reduce complications.It can effectively reduce the damage to patients and reduce the cost of surgery for patients.
作者
姚佳明
曹葆强
胡金龙
胡知齐
YAO Jiaming;CAO Bao-qiang;HU Jin-long(The Second Hospital of Hefei,Hefei 230041,China)
出处
《肝胆外科杂志》
2020年第4期274-277,共4页
Journal of Hepatobiliary Surgery
关键词
胆道手术
胆漏
负压吸引引流
肝胆外科手术
非手术治疗
biliary surgery
bile leakage
vacuum suction drainage
hepatobiliary surgery
non-surgical treatment
