肝圆韧带与带蒂大网膜覆盖T管引流周围预防早期拔管胆漏的作用研究  

Clinical application of liver round ligament and greater omentum in prevention of bile leakage caused by early extubation of T-tube

作　　者：段建平[1] 罗序超 叶斌[1] 杨宁[1] 李志刚[1] 黄治国[1] 罗庆林[2] 何华[2] 叶剑辉[3] 

机构地区：[1]南雄市人民医院普外科,广东省512400 [2]南雄市人民医院功能影像科,广东省512400 [3]南雄市人民医院信息科,广东省512400

出　　处：《中华普外科手术学杂志（电子版）》2015年第2期33-36,共4页Chinese Journal of Operative Procedures of General Surgery(Electronic Edition)

基　　金：广东省韶关市科学技术研究基金项目(Y14196)~~

摘　　要：目的探讨胆道手术T管引流术后早期拔管的方法和可行性分析。方法自2010年1月至2015年1月的60例胆总管探查手术患者,将其随机分为A、B两组。A组（30例）采用胆总管探查常规T管固定手术治疗;B组（30例）采用胆总管探查肝圆韧带内走行T管联合带蒂大网膜包绕T管手术治疗,B组术后第6、9、12天行腹部超声/CT检查了解窦道形成情况指导拔除T管。应用SPSS17.0对以上患者的相关数据进行处理。术中出血量、手术时间、住院时间、住院费用、术后T管胆汁引流总量、术后T管拔除时间等计量资料比较用t检验,术后胆漏计数资料用χ2检验,P〈0.05具有统计学差异。结果通过腹部超声/CT检查检测示：术后1周T管窦道壁的平均厚度为4~5 mm,且T管窦道基本形成,随着时间的增加窦道更加完整和清晰。B组30例患者中术后8 d拔管14例（46.7%）,10 d拔管15例（50.0%）,12 d拔管1例（3.3%）,拔管后均未出现胆漏。B组术后T管胆汁引流总量和术后T管拔除时间分别为（2 105±460）ml和（10.0±2.0）d,明显少于A组的（3 742±660）ml和（17.0±3.0）d,（P=0.007）;B组住院时间和住院费用分别为（11.3±2.1）d和（19 145.8±1 035.4）元,明显少于A组的（18.5±2.5）d和（28 180.2±2 548.9）元,（P=0.006）;以上比较差异均有统计学意义（P〈0.01）。结论利用肝圆韧带内走行T管联合带蒂大网膜包绕T管的方法,不仅可以早期拔除T管,有效减少胆汁的流失和胆漏的发生,而且减少了住院时间和住院费用,具有很好的临床应用前景。Objective To investigate the method and feasibility of early extubation after biliary tract operation with T-tube drainage. Methods From January 2010 to January 2015, 60 patients with common bile duct exploration were randomly divided into group A and group B. In group A, 30 patients were subjected to common bile duct exploration and conventional T-tube fixed surgery; in group B, 30 patients underwent common bile duct exploration and T-tube drainage. In group B, abdominal uhrasound/CT examination were done on postoperative days 6, 9 and 12 to guide the extubation of the T-tube. Statistical analysis was performed by using SPSS17.0 software. Measurement data, including intraoperative blood loss, operative time, hospital stay, hospitalization expense, postoperative bile T-tube drainage volume, postoperative T-tube removal time, were compared by Student＇s t test. The Incidence of postoperative bile leakage was compared by the chi-square test （P 〈 0.05）. Results Abdominal ultrasound/CT showed that the thickness of fistular wall was 4-5 mm one week after operation. In group B, 14 patients （ 46.7% ） underwent extubation on postoperative day 8, 15 （50.0%） on day 10 and 1 （3.3%） on day 12; no bile leakage occurred after extubation. In group B, T-tube bile drainage volume and postoperative T-tube removal time were （2 105±460） ml and （10.0 ± 2.0） d respectively, which were significantly lower than those in group A （3 742 ± 660） ml and （ 17.0± 3.0） d, （ P = 0. 007）. In group B, the length of hospital stay and hospitalization expenses were （ 11.3 ± 2.1 ） d and （ 19 145.8 ±1 035.4） RMB yuan respectively, which were significantly lower than those in group A （18.5±2.5） d and （28 180.2±2 548.9） RMB yuan （P = 0. 006）. Conclusions Decreased incidence of bile leakage, reduced hospital stay and hospitalization expenses could be achieved after application of the liver round ligament and greater omentum in prevention of bile leakage caused by early extubation of T-tube

关 键 词：胆管疾病 胆道外科手术 引流术 

分 类 号：R657.4[医药卫生—外科学]