经皮肝胆管造瘘硬镜碎石术中灌洗液总量的安全范围初探

Safety range of total amount of lavage fluid in percutaneous Hepatocholangiostomy in combination with rigid nephroscope

目的探讨经皮肝胆管造瘘硬镜碎石取石手术中灌洗液总量的安全范围。方法回顾性分析2014年6月至2018年11月在海南医学院附属海南医院肝胆胰外科接受经皮肝胆管造瘘硬镜碎石手术的7例患者9人次的手术资料,记录术中总共经高压灌洗泵冲洗肝内胆管的液体总量、体外引流量和停留在患者消化道液体量。记录患者术后腹胀、呕吐、肛门排气时间、是否有水电解质或酸碱平衡紊乱情况发生。结果手术时间为1 h 35 min^4 h 30 min,冲洗液为等渗生理盐水6 000~45 000 mL,溢出到手术台两侧的液体收纳桶中的量为3 060~24 150 mL,术中胃管开放引出冲洗液200~1 900 m L,估算实际进入人体内液体总量3 750~7 750 mL。肛门排气时间2~36 h。无一例患者出现水电解质或酸碱平衡紊乱、术中未见误吸和术后呕吐。结论在有限的病例观察中,经皮肝胆管造瘘硬镜碎石术中灌洗液总量上限可达到45 000 mL,进入人体实际总量上限可达7 750 mL,未见水电解质或酸碱平衡紊乱、未见术中误吸和术后呕吐。

Objective To investigate the safety range of the total amount of lavage fluid in percutaneous hepatocholangiostomy in combination with rigid nephroscope. Methods From June 2014 to November 2018, the data of 7 patients (9 operations) who underwent percutaneous hepatocholangiostomy in combination with rigid nephroscope from June 2014 to November 2018 in the Department of Hepatobiliary and Pancreatic Surgery, Hainan Hospital Affiliated to Hainan Medical College, were retrospectively analyzed. The total amount of lavage fluid, extracorporeal drainage, and gastrointestinal fluid retention were recorded. Postoperative abdominal distension, vomiting, anal exhaust time, the occurrence of water electrolyte or acid-base balance disorders were recorded. Results The operation duration was 1 hour plus 35 minutes to 4 hours plus 30 minutes, and the volumes of lavage fluid (isotonic saline) was 6 000 mL to 45 000 mL. The amount of fluid spilled into the liquid storage bucket on both sides of the operating table was 3 060 mL to 24 150 mL, and the irrigating fluid was 200-1 900 mL during the operation. The total amount of liquid actually entering the human body was estimated to be 3 750-7 750 mL. Anal exhaust time ranged from 2 hours to 36 hours. None of the patients suffered from the disorder of water electrolyte or acid-base balance, aspiration, and postoperative vomiting. Conclusion In the case of limited observation, the upper limit of the total amount of lavage fluid in percutaneous hepatocholangiostomy maybe up to 45 000 mL, and the actual total amount of fluid entering into human body maybe up to 7 750 mL. No aspiration, postoperative vomiting, water electrolyte or acid-base balance disorders were found.