36例胆道探查T管引流术后并发症的原因及防治

MANAGEMENT OF POSTOPERATIVE COMPLICATIONS IN PATIENTS WITH BILIARY TRACT EXPLORATION AND T-TUBE DRAINAGE:REPORT OF 36 CASES

目的探讨胆道探查T管引流术后并发症发生的原因及其防治措施.方法对1986～2002年间我院行972例胆道探查T管引流术后发生并发症的36例临床资料作回顾性分析.结果36例并发症中胆瘘或胆汁性腹膜炎20例.胆道出血3例.胆道蛔虫症2例.T管压迫胃十二指肠致不全梗阻1例.T管拔断遗留胆总管内1例.术后胆汁引流量异常2例.术后黄疸急剧加深1例.并发急性胰腺炎2例.T管不能夹闭(胆道结石残留)3例.T管致胆道结石形成1例.本组保守治疗21例(58%),再手术治疗15例(42%).除1例并发急性坏死性胰腺炎死亡、1例并发低渗性脱水、营养不良自动出院外,其余均痊愈出院.结论发生并发症的原因主要与手术操作技术、术后处理以及患者本身疾病、机体状况等有关.恰当的术中操作与术后处理以及针对患者自身不良因素积极采取相应的治疗是预防术后并发症发生的主要措施.

Objective To study the causes and management of postoperative complications in patients with biliary tract exploration an T-tube drainage. Methods Clinical data of 36 patients who have underwent biliary tract exploration and T-tube drainage between 1986 and 2002 were studied retrospectively. Result Bilary fistula or bile peritonitis occureed in 20 cases,bile duct hemorrhage in 3 and ascariasis in 2,gastroduodenal incomplete obstraction in 1 ,the remnants of T-tube in 1,abnormity of bile drainage quantity in 2,jaundice exacerbation in 1 ,acute pancreatitis in 2,T-tube could not be closed in 3 and lithogenesis in 1.21 patients underwent conservative therapy（58%）, 15 reoperation （42%）. complications were cured in 34 cases,one who suffering from acute necrotic pancreatitis dies,the other was voluntary discharged from hospital resulted from hypotonic dehydration and malnutrition, iously lower in expermental group than . Conclusion Some complications were related to the operative handle and the expertise,others were related to the disease and patient＇s condition. Suitable operative handle, postoperative rational therapy and every measures improving the patient＇s general condition were important in preventing the complications.