新型窦道冲洗负压引流在胰十二指肠切除术后腹腔感染治疗中的应用分析  

Analysis of the application of novel sinus tract irrigation with negative pressure drainage in the treatment of abdominal infections after pancreaticoduodenectomy

作　　者：董杰杰 张彤 姚鹏[1] 李小争[1] Dong Jiejie;Zhang Tong;Yao Peng;Li Xiaozheng(Department of Hepatobiliary Surgery,Yuncheng Central Hospital Affiliated to Shanxi Medical University,Yuncheng 044000,China)

机构地区：[1]山西医科大学附属运城市中心医院肝胆外科,运城044000

出　　处：《中华肝胆外科杂志》2024年第9期678-683,共6页Chinese Journal of Hepatobiliary Surgery

基　　金：运城市中心医院院级课题(YJ2023080)。

摘　　要：目的探索胰十二指肠切除(PD)术后腹腔感染冲洗治疗过程中原腹腔引流管因引流并发症拔除后的有效替代引流方式。方法回顾性分析山西医科大学附属运城市中心医院肝胆外科2020年8月至2023年8月39例PD术后腹腔感染因引流并发症更换引流管继续行冲洗引流治愈患者的临床资料,其中男性23例,女性16例,年龄(54.8±9.6)岁。依据不同换管方式39例患者分为观察组(n=21),经原腹腔引流管窦道置入一根冲洗管联合腹腔外部负压吸引;对照组(n=18),经原腹腔引流管窦道置入两根并行引流管冲洗引流。对比两组换管前原发肿瘤分类、PD术后胰瘘及胆瘘发生率、腹腔引流并发症、PD手术至换管时间以及换管后住院时间、住院费用、腹腔持续冲洗时间、发热和白细胞升高比例、换药次数等。结果换管前两组原发肿瘤分类、PD术后胰瘘及胆瘘发生率、腹腔引流并发症、PD手术至换管时间等比较,差异均无统计学意义(均P>0.05)。换管后观察组住院时间、住院费用、腹腔持续冲洗时间、发热和白细胞升高比例、换药次数均低于对照组(6.7±1.2)d比(15.1±4.4)d、(19985±6535)元比(39623±15479)元、4.0(3.0,5.0)d比9.0(8.0,10.8)d、23.8%(5/21)比55.6%(10/18)、28.6%(6/21)比66.7%(12/18)、10.0(7.0,13.0)次比22.0(18.2,27.0)次,差异均有统计学意义(均P<0.05)。结论经原腹腔引流管窦道置入一根冲洗管联合腹腔外部负压引流是治疗PD术后腹腔感染的有效替代引流方式,具有冲洗引流效果好,冲洗时间短,腹腔感染控制早的优势。ObjectiveTo evaluate an effective manner to replace the drainage tube due to drainage complications during the irrigation treatment of abdominal infection after pancreaticoduodenectomy(PD).MethodsClinical data of 39 patients with abdominal infection after PD due to drainage complications who were successfully treated by replacement of the drainage tubes with continued flushing in the Department of Hepatobiliary Surgery,Yuncheng Central Hospital Affiliated to Shanxi Medical University from August 2020 to August 2023 were retrospectively analyzed,including 23 males and 16 females,aged(54.8±9.6)years.According to the fashion of tube replacement,patients were divided into the observation group(n=21),in which a flushing tube was placed through the original abdominal drainage tube sinus tract combined with external negative pressure suction;and the control group(n=18),in which two parallel drainage tubes were placed through the original abdominal drainage tube sinus tract for flushing and drainage.The two groups were compared in terms of indicators before tube replacement,including the primary tumor classification,incidence of pancreatic fistula and biliary fistula after PD,complications of abdominal drainage,time from the surgery to tube replacement;and indicators after tube replacement,including total hospital stay,hospitalization cost,continuous abdominal lavage time,fever and elevated white blood cell count,number of dressing changes,etc.ResultsThere were no significant difference in the primary tumor classification,incidence of pancreatic fistula and biliary fistula after PD,complications of abdominal drainage,and time from PD to tube replacement between the two groups before tube replacement(all P>0.05).After tube replacement,the total hospitalization time(32.7±1.9 vs 44.7±14.5,d),hospitalization cost(67604±16052 vs 91845±19826,yuan),continuous abdominal lavage time[4.0(3.0,5.0)vs 9.0(8.0,10.8),d],fever[23.8%(5/21)vs 55.6%(10/18)]and leukocytosis rate[28.6%(6/21)vs 66.7%(12/18)],and times of dressing change

关 键 词：胰十二指肠切除术 术后胰瘘 腹腔感染 腹腔引流管窦道 负压引流 

分 类 号：R657.5[医药卫生—外科学]