腹腔引流管拔管相关并发症的处理及预防  

Treatment and prevention of complications related to extubation of abdominal drainage tube

作　　者：肖广远 周君[1] 陈炳荣 沈彬[1] 肖卫星[1] 周海军[1] XIAO Guang-yuan;ZHOU Jun;CHEN Bing-rong;SHEN Bin;XIAO Wei-xing;ZHOU Hai-jun(Jiaxing Hospital of Traditional Chinese Medicine,Jiaxing,Zhejiang 314000,China)

机构地区：[1]嘉兴市中医医院普外科,浙江嘉兴314000

出　　处：《肝胆胰外科杂志》2021年第4期213-215,222,共4页Journal of Hepatopancreatobiliary Surgery

摘　　要：目的探讨腹部手术后腹腔引流管拔管相关并发症出现的原因、处理方法及预防措施。方法回顾性分析2015年10月至2020年10月期间嘉兴市中医医院普外科1 189例行腹部手术并放置腹腔引流管患者的临床资料。结果 1 189例腹部手术中28例出现腹腔引流管拔管相关并发症,主要包括困难性拔管5例,腹腔出血5例,引流管断裂3例,T管固定线脱落胆漏2例,皮肤瘘管形成3例及大网膜疝10例。困难性拔管经反复尝试均顺利拔出;腹腔出血经再次手术止血治疗痊愈;引流管断裂经再次手术取出残端;胆漏患者行腹腔穿刺引流保守治疗后康复;皮肤瘘管病程长,治愈缓慢;大网膜疝患者部分可轻轻回纳即可,若合并出血可结扎止血后回纳腹腔;各并发症经处理均取得良好临床效果。结论腹腔引流管拔管并发症在临床上时有发生,一旦出现需及时处理。临床医师需加强防范意识,实施有效的预防措施,尽量减少引流管拔管相关并发症。Objective To investigate the causes,treatment and prevention measures of complications related to extubation of abdominal drainage tube after abdominal surgery.Methods A total of 1189 patients who underwent abdominal surgery and postoperative abdominal drainage in Jiaxing Hospital of Traditional Chinese Medicine from Oct.2015 to Oct.2020 were analyzed retrospectively.The types of complications related to extubation and the causes were summarized and analyzed to investigate effective prevention measures.Results Among 1189 patients,28 had extubation-related complications,including 5 cases of difficult extubation,5 cases of abdominal hemorrhage,3 cases of drainage tube rupture,2 cases of T-tube fixation line shedding and bile leakage,3 cases of skin fistula formation and 10 cases of omentum hernia.The difficult extubations were successfully removed after repeated attempts.Two cases of abdominal hemorrhage were cured by reoperation to stop the bleeding.The ruptured drainage tube was removed by reoperation.Patients with bile leakage were recovered after conservative treatment with abdominal puncture and drainage.The skin fistulas had long clinical courses.The omentum was ligated when necessary before putting back into the enterocoelia.All complications were properly treated and the clinical results were good.Conclusion Complications related to extubation of adominal drainage tube occur frequently in clinical practice.Once occurred,complications should be disposed in time.Clinicians need to strengthen their awareness of prevention and implement effective prevention measures,to minimize the incidence of complications.

关 键 词：腹腔引流管 拔管相关并发症 腹腔出血 胆漏 皮肤管瘘 大网膜疝 

分 类 号：R656.6[医药卫生—外科学] R619[医药卫生—临床医学]