拔T管后胆漏的原因分析及防治体会

Causes analysis,prevention and treatment experience of biliary leakage after pulling out of T-tube

目的:探讨拔除T管后引发胆漏的原因及防治措施。方法:对1998年4月—2006年3月间7例拔除T管后引发胆漏患者的临床资料进行回顾性分析。结果:7例患者中5例经T管窦道插入适宜引流管和/或超声引导下腹腔穿刺引流保守治愈,2例二次手术痊愈。结论:胆漏发生主要与患者自身原因及手术操作欠规范、胆管切口缝合不当等医源性原因有关。术中处理好胆总管缝合技术与T管放置要领,术后选择适宜的拔管时间是预防T管拔除后胆漏的关键;发生胆漏后积极保守治疗,多数患者可痊愈,若观察引流效果欠佳、腹部体征加重,应尽早手术治疗。

Objective: Discussion measures about causes,prevention and treatment of bile leakage after pulling out of T-tube.Methods:In our hospital from April 1998 to March 2006 of seven cases of T-tube extraction of bile leakage caused after the patient′s clinical data were analyzed retrospectively.Results:Seven patients in five cases by T-tube sinus drainage tube inserted into appropriate and/or abdominal ultrasound-guided puncture drainage conservative cured,two cases of secondary recovery operations.Conclusion:Bile leakage occurred and the patient′s own main reasons for surgical operation and less standardized,bile duct sutured incision inappropriate iatrogenic factors.In the handling of the common bile duct suture technology and T-tube placed essentials,choose appropriate after extubation time is to prevent T-tube extraction of bile leakage after the key bile leakage occurred after a positive conservative treatment,most patients can be more,if the observed effect of drainage poor,abdominal signs of deteriorated surgical treatment should be as soon as possible.