术中经胆管残端注射亚甲蓝稀释液在肝包虫病术后胆汁漏中应用的随机对照研究  

Clinical significances of intraoperative methylene blue diluent injection through residual bile duct for bile leakage after hepatic hydatidosis surgery:a randomized controlled trial

作　　者：陈见中 罗斯满 喻定刚 CHEN Jianzhong;LUO Siman;YU Dinggang(Department of Hepatobiliary Pancreatic Surgery,People’s Hospital of Aba Tibetan and Qiang Autonomous Prefecture,Maerkang,Sichuan 624000,P.R.China)

机构地区：[1]阿坝藏族羌族自治州人民医院肝胆胰外科,四川马尔康624000

出　　处：《中国普外基础与临床杂志》2020年第10期1272-1276,共5页Chinese Journal of Bases and Clinics In General Surgery

基　　金：阿坝州科学技术和知识产权局项目(项目编号:19YYJJYJ0005)。

摘　　要：目的探讨术中经胆管残端注射亚甲蓝稀释液在肝包虫病术后胆汁漏中的临床意义。方法对阿坝藏族羌族自治州人民医院2018年12月至2019年11月期间收治的肝包虫病患者随机分为研究组和对照组。研究组肝包虫病根治术后,创面严格止血,阻断第一肝门,然后经胆管残端注射亚甲蓝稀释液检查胆汁漏,发现胆汁漏予以修补,术后留置引流管;对照组采用白纱布法压迫肝脏创面5 min检查胆汁漏,其他方法与研究组一致。比较2组患者的手术时间、术中出血量、术中胆汁漏检出率、术后第3天时的肝功能(总胆红素、丙氨酸氨基转移酶、白蛋白)、术后并发症、术后住院时间和总费用。结果本研究根据纳入和排除标准共纳入67例患者,其中研究组32例,对照组35例,2组患者的年龄、性别、术前并发症、术前肝功能及肝包虫分型比较差异均无统计学意义(P>0.05)。2组患者的手术均成功,无围术期死亡病例。研究组术中胆汁漏检出率高于对照组(53.1%比17.1%,P<0.05),研究组的术后住院时间短于对照组且总住院费用较对照组更低(P<0.05),2组患者的手术时间、术中出血量、术后第3天时的肝功能比较差异均无统计学意义(P>0.05)。研究组术后无一例发生切口感染、胆汁漏及残腔感染,而对照组分别有1、5和4例发生,切口感染和胆汁漏发生率2组比较差异有统计学意义(P<0.05),2组其他并发症发生率比较差异均无统计学意义(P>0.05)。结论术中经胆管残端注射亚甲蓝稀释液在肝包虫病术中胆汁漏检出率高,可有效防止术后胆汁漏发生、缩短术后住院时间及减少费用。Objective To investigate the clinical significances of intraoperative methylene blue diluent injection through the residual bile duct for bile leakage after hepatic hydatidosis surgery.Methods The patients with hepatic hydatidosis who received the surgical treatment in this hospital from December 2018 to November 2019 were randomly divided into a study group and control group.The patients in the study group received the treatment of anatomical or nonanatomical hepatic lobectomy.The first hepatic hilum was locked,then the methylene blue diluent was injected through the residual bile duct to find the bile leakage.The drainage tube was retained in the abdominal cavity after the surgery.The patients in the control group except the white gauze was used to compress the liver wound surface for 5 min to find the bile leakage,the other treatment process was the same as the study group.The operation time,intraoperative blood loss,liver function on day 3 after the surgery(total bilirubin,alanine aminotransferase,albumin),detection rate of bile leakage during operation,postoperative complications(pulmonary infection,ascites,incision infection,bile leakage,residual cavity infection,and electrolyte disturbance),postoperative hospitalization time,and total hospitalization cost were compared between two groups.Results According to the inclusion and exclusion criteria,67 patients were included in this study,including 32 in the study group and 35 in the control group.There were no significant differences in the baseline data such as the age,gender,preoperative complications,preoperative liver function(total bilirubin,alanine aminotransferase,albumin),and liver hydatid classification between the two groups(P>0.05).The operations were successful in the 67 patients,no perioperative death occurred.The detection rate of bile leakage during operation in the study group was higher than that in the control group(53.1%versus 17.1%,P<0.05).The postoperative hospitalization time was shorter and the total hospitalization cost was lower in the

关 键 词：肝包虫病 肝叶切除 并发症 胆汁漏 

分 类 号：R657.3[医药卫生—外科学]