腹部手术引流的正确置放和引流物判断

Drainage of the abdomen,proper selection and evaluation

腹腔引流虽广泛采用,但使用不合理的现象仍十分突出,主要表现在不加选择地常规放置,其原因在于对腹腔引流的风险认识不足,腹腔引流不能替代完美的手术和对病灶的满意处理。对择期手术,应争取将手术做到完美,达到不需要放置引流的程度;对急诊手术或病灶处理不满意的手术,应有选择、有目的地放置引流。引流管放置时间过长或滥放,不但达不到引流的目的,而且可能继发感染,并妨碍病人康复。预防性引流应以封闭式引流为主,治疗性引流可使用负压冲洗引流。引流物的量和性质不一定能够准确反映腹腔内的情况,应结合其他临床资料综合判断。

Although widely used in the clinic, abdominal drainage is often used improperly, the reason for which is inadequate knowledge about its complications. Drainage is not an alternative to satisfactory operation, nor can it make up the defect of surgery. The ultimate goal of surgery should be perfect operation with no need for drainage. In the selective cases with clear purposes we ean use drainage. A sustained drainage may not drain adequately, and ascending bacterial infection may follow, it also hinders the ambulation of patients. Closed drainage is suitable for prophylactic use, and therapeutic drainage is often vacuum assisted. The drained fluid may not reflected the real event in the abdomen, and general analysis based on the history, physical findings and imaging studies should be made.