胆道探查T管引流术后严重并发症41例临床分析

Analysis of postoperative severe complications in 41 patients undergoing biliary tract exploration and T-tube drainage

目的探讨胆道探查T管引流术后严重并发症发生的原因及其防治措施。方法对1998年1月～2009年12月间行1456例胆道探查T管引流术后发生严重并发症的41例患者临床资料作回顾性分析。结果 41例患者中胆瘘或胆汁性腹膜炎23例(56.1%),胆道出血5例(12.2%),T管压迫胃十二指肠致不全梗阻2例(4.9%),T管拔断遗留胆总管内1例(2.4%),术后胆汁引流量异常4例(9.8%),术后黄疸急剧加深1例(2.4%),并发急性胰腺炎5例(重症2例、轻症3例)(12.2%)。41例患者中保守治疗26例(63.4%),再手术治疗15例(36.6%)。除1例患者并发急性坏死性胰腺炎死亡、1例患者并发低渗性脱水、营养不良自动出院外,其余均痊愈出院。结论发生严重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 investigate the causes and management of postoperative severe complications in patients who underwent biliary tract exploration and T-tube drainage. Methods Clinical data of 41 patients who underwent biliary tract exploration and T-tube drainage between January 1998 to December 2009 were studied retrospectively. Results Biliary fistula or bile peritonitis occurred in 23 patients, bile duct hemorrhage in 5, and gastroduodenal incomplete obstruction in 2, remnants of T-tube in 1, abnormal quantity of bile drainage in 4 ,jaundice exacerbation in 1, and acute pancreatitis in 5. Twenty-six patients （63.4%） underwent conservative therapy,and 15 （36.6%） underwent reoperation. Complications were cured in 39 patients, except one who suffered from acute necrotic pancreatitis died and one had hypotonic dehydration and malnutrition after voluntary discharge from the hospital. Conclusions Some complications are related to operative management and expertise, and others are related to the conditions of the disease and patient. Proper management and postoperative rational therapy and measures taken to improve the patient＇s general condition are essential to preventing any complications after biliary tract exploration and T-tube drainage.