胆漏17例治疗体会

Experience of 17 Cases of Gallbladders Breaking

目的 预防和治疗胆漏，提高对拔Ｔ 管后致胆漏及外伤致胆漏的再认识；方法 对收治的胆总管探查７３３ 例，拔Ｔ 管后引起胆汁性腹膜炎１６ 例的统计学分析、病史的探讨及合并症的研究；结果 拔Ｔ 管后出现胆漏与病人的合并症、年龄、体质有关，与拔管时间的长短关系不大；结论 合并症的治疗应是预防拔Ｔ管后出现胆漏的关键，拔Ｔ 管的时间应遵循传统，拔Ｔ 管前“拍三片”，以便正确了解左、右肝管以及胆总管下段的情况，外伤须剖腹探查时， 做到全面、系统、彻底，充分估计到损伤的多发性，防止出现漏诊。

Objective To prevent and treat gallbladders breaking,promote the knowledges about gallbladder breaking by the extraction of T-tube and the trauma.Methods Giving statistical analysis to 733 cases of choledochus exploration and 16 cases of choleperitoneum after the extraction of T-tube,and research the history and complications.Results The appearance of gallbladders breaking after the extraction of T-tube was related to the patient's complications, age and constitution, and had not much to do with the extraction time. Conclusion i, The treating of complication is the key to prevent gallbladders breaking after the extraction of T-tube.ii, The extraction time should obey tradition.iii,The 'Three Photographys'should be taken before the extraction of T-tube,which will help to know right and left hepatic canals and lower part of choledochus.iiii,When dissection exploration must be given to the wound,we should estimate the multiplex of the wound,systematically and sufficiently and prevent missed diagnosis.