经中心静脉导管介入治疗腹部外科疾病并发症  

Percutaneous central venous catheter drainage for interventional treatment of complications in abdominal surgical diseases

作　　者：陈新[1] 宣之东[2] 祝志[3] 

机构地区：[1]沧州市中心医院普外一科,河北省沧州061001 [2]沧州市中心医院超声科,河北省沧州061001 [3]沧州市中心医院放射科,河北省沧州061001

出　　处：《中国基层医药》2012年第11期1652-1653,共2页Chinese Journal of Primary Medicine and Pharmacy

摘　　要：目的探讨经中心静脉导管介入治疗腹部外科疾病并发症的效果。方法回顾性分析72例腹部外科疾病患者的临床资料，其中并发腹水23例、胆漏19例、胰瘘8例、胰腺组织坏死7例、腹腔脓肿15例，均行超声或CT引导下置人中心静脉导管引流治疗。结果72例患者均一次性置入中心静脉导管成功，导管留置时间2—37d，5例患者带管出院，定期至门诊复查。3例腹水患者导管滑脱行重新置管；发生导管堵塞17例，经冲洗和导丝疏通后解除；胰腺组织坏死2例和胰周脓肿1例行多次穿刺并更换大151径导管后治愈。胰腺组织坏死2例、外伤性胰漏1例、阑尾炎1例患者均行开腹手术；胆囊切除术后胆漏1例行胆道内支架治疗；重症胰腺炎并发呼吸窘迫综合征1例转入ICU治疗。结论超声或CT引导下在腹腔置人中心静脉导管治疗腹部外科疾病并发症，安全、有效，值得推广应用。Objective To discuss the effica of central venous catheter drainage in interventional treatment of abdominal surgical complications. Methods The clinical data of 72 cases of abdominal surgical diseases were retrospectively analyzed, the complications included 23 cases of ascites, 19 cases of bile leakage,8 cases of pancreatic fistula,7 cases of pancreatic necrosis and 15 cases of abdominal abscess, they all underwent percutaneous central venous catheter drainage under the guidance of ultrasound or CT. Results Central venous catheter was placed in 72 cases successfully in one time, the catheters were kept for 2 to 37 days,5 discharged cases with catheter underwent regular reexamination in the clinic. 3 cases of ascites were replaced for catheter shedding; 17 cases for occlusion recieved catheter irrigation and guidewire dredging;2 cases of pancreatic necrosis and 1 case of peripancreatic abscess were cured by repeated puncture and replacement of large-bore catheter. 2 cases of pancreatic necrosis, 1 case of pancreatic fistula and 1 case of appendicitis underwent laparotomy finally;1 case of postcholecystectomy bile leakage underwent endoscopic stent therapy; 1 cases of severe pancreatitis complicated with ARDS was treated in ICU. Conclusion Central venous catheter drainage guided by ultrasound or CT for treatment of abdominal surgical complications was not only safe but also effective, and is worthy of popularization and application.

关 键 词：腹腔 并发症 中心静脉导管 引流 

分 类 号：R656[医药卫生—外科学]