双腔T管的研制及临床应用  

Design and clinical application of a double lumen T tube

作　　者：管清海[1,2] 陈强谱[1,2] 张兴元[1,2] 张帆[1,2] 卢艳敏[1,2] 夏国华[1,2] 张长习[1,2] 曹学峰[1,2] 欧琨[1,2] 

机构地区：[1]山东省滨州医学院附属医院肝胆外科 [2]山东省滨州医学院附属医院临床营养支持中心,山东省滨州市256603

出　　处：《世界华人消化杂志》2015年第31期5056-5063,共8页World Chinese Journal of Digestology

摘　　要：目的:探讨双腔T管制作方法和研究其流体力学特性,评价临床应用技术和使用效果.方法:对滨州医学院附属医院肝胆外科1989-03/2015-03行胆道手术中放置双腔T管的患者临床资料进行回顾性分析,介绍双腔T管的制作、放置、使用方法,对双腔T管的流体力学特性进行研究探讨,统计分析其使用过程中的并发症发生率,评价在胆道冲洗、胆汁培养、胆道造影及肠内营养方面的临床应用效果.结果:依据制作的双腔T管的功能,我们将其分为两种类型:Ⅰ型(胆道冲洗用双腔T管)和Ⅱ型(肠内营养用双腔T管).Ⅰ型双腔T管放置时,短臂置于肝外胆管内,长臂经腹腔自腹壁引出体外;内管放置于肝内二级或三级胆管,据情况放置于左侧或右侧肝管内,内管体外端接生理盐水行胆道冲洗.Ⅱ型双腔T管短臂置于肝外胆管内,长臂经腹腔自腹壁引出体外;内管经十二指肠乳头或胆肠吻合口,放入十二指肠或空肠内,管端一般应放置在乳头或吻合口以下20-30 cm,内管体外端接营养液行肠内营养.1020例患者应用双腔T管,其中应用Ⅰ型双腔T管660例、Ⅱ型双腔T管360例.带管时间5-92 d,平均23.5 d.T管脱出2例(0.20%)、堵塞12例(1.18%),T管周围感染23例(2.26%),胆道出血2例(0.2%),拔出困难1例(0.1%),胆瘘11例(1.08%),拔管后腹膜炎2例(0.2%).655例患者用于胆道冲洗,3 4 3例进行了胆汁细菌培养,胆道冲洗后胆汁细菌培养阳性率较普通T管患者下降;6 5 7例患者行胆道造影,胆道显影满意率98.2%;358例患者应用Ⅱ型双腔T行肠内营养,314例患者同时进行外引流胆汁及胰液的回输.结论:双腔T管较普通T管增加了冲洗、造影、采集胆汁及肠内营养等作用,其设计合理、制作简便、并发症少、安全可靠,可适用于多种胆道手术,对提高胆道疾病的治疗效果、保证胆道手术后的安全有积极作用.AIM：To design a double lumen T tube,investigate its hydro dynamic characteristics,and assess its clinical application.METHODS：A retrospective study was carried out to analyze the data of patients who underwent biliary tract operations with placement of a double lumen T tube from March 1989 to March 2015 at the Department of Hepatobihary Surgery of Binzhou Medical University Hospital.This study introduced the design,placement and operational method of the double lumen T tube,investigated its hydrodynamic characteristics,analyzed the complications,and assessed its clinical application in biliary tract irrigation,bile culture,cholangiography and enteral nutrition.RESULTS：Based on the function of double lumen T tube,it was divided into two types：I（for biliary irrigation） and type II（for enteral nutrition）.For type I double lumen T tube,the short arm was placed in the extrahepatic bile duct,and the long arm was brought out through the abdominal wall;the inner tube was placed in left or right secondary or tertiary intrahepatic bile duct,with the end outside the body connected to saline for flushing.For type II double lumen T tube,the short arm was placed in the extrahepatic bile duct,and the long arm was brought out through the abdominal wall;the inner tube was placed into the duodenum or jejunum through the duodenal papilla or anastomotic stoma,with the end outside the body connected to nutrition solution for enteral nutrition.A total of 1020 patients underwent placement of the double lumen T tube,including660 who used type I and 360 who used type II tube.T tube placement time was5-92 d,with an average value of 23.5 d.Complications included T tube dislocation（2 cases,0.20%）,lumen blockage（12 cases,1.18%）,infection around T tube（23 cases,2.26%）,hemobilia（2 cases,0.2%）,difficulty in removing（1 case,0.10%）,biliary fistula（11 cases,1.08%）,and peritonitis after T tube removal（2 cases,0.20%）.Moreover,665 cases underwent biliary tract irrigation,and bile culture was performed in 34

关 键 词：T管 冲洗引流 肠内营养 胆道造影 细菌培养 

分 类 号：R608[医药卫生—外科学]