腹腔镜胆囊切除术后腹腔引流管意外拔出是否再放置的临床研究

Clinical investigation of accidental removal of abdominal drainage tube after laparoscopic cholecystectomy

目的探讨腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)术后非医嘱拔出腹腔引流管后是否再放置的讨论。方法选择2014年1月至2018年1月就诊于普外科行腹腔镜胆囊切除患者1462例,选择其中36例引流管意外脱出且未再次放置的患者为研究组,其他正常医嘱拔管的36例患者为对照组。记录2组患者住院时间,术后排气时间,术后并发症发生情况和视觉模拟评分法(visual analogue scale,VAS)。结果研究组术后排气时间多于对照组,差异有统计学意义(P<0.05)。2组患者住院时间差异无统计学意义(P>0.05)。研究组患者术后并发症发生率为11.11%(4/36),对照组为13.89%(5/36),差异无统计学意义(P>0.05)。研究组患者VAS评分为(2.60±1.10)分,对照组为(2.41±1.32)分,2组差异无统计学意义(P>0.05)。结论在手术过程顺利的LC手术后,若意外腹腔引流管拔出后,不再重新放置引流管不会明显增加术后并发症、术后疼痛程度及住院时间,安全性可;但最终还是要取决于手术医师的经验判断。

Objective To investigate whether to replace the abdominal drainage tube after laparoscopic cholecystectomy(LC)or not.Methods A total of 1462 patients who underwent laparoscopic cholecystectomy in our hospital from January 2014 to January 2018 were enrolled in the study,of whom,36 patients who underwent accidental prolapse of drainage tube that was not replaced were enrolled as research group,and the other 36 patients whose drainage tubes were removed according to medical order were enrolled as control group.The hospital stay,postoperative venting time,postoperative complications,and visual analogue scale(VAS)were observed and compared between the two groups.Results The postoperative exhaust time in research group was significantly longer than that in control group(P<0.05).There were no significant differences in the hospitalization stays between the two groups(P>0.05).The incidence rate of postoperative complications in research group was 11.11%(4/36),which was 13.89%(5/36)in control group,there was no significant difference between the two groups(P>0.05).Moreover the VAS scores in research group were(2.60±1.10)points,which in control group were(2.41±1.32)points,there were no significant differences between the two groups(P>0.05).Conclusion After the successful LC procedure,the non-reset of drainage tube after accidental prolapse of drainage tube may not increase the postoperative complications,postoperative pain and hospitalization time,with better safety.However the ultimate treatment scheme depends on the experience and evaluation of the surgeons who perform the operation.