外科引流在肝脏外科的应用体会

The Clinical Experience of Surgical Drainage in Hepatectomy (A Report of 97 Cases)

目的 探讨外科引流在肝脏外科中的临床应用价值。 方法 近十年来收治各类肝脏外科手术病例 97例 ,其中肝癌 5 7例 ,肝外伤破裂 2 6例 ,肝血管瘤 5例 ,结肠癌肝转移 7例 ,巨大肝囊肿 2例。术中常规于膈下、肝下和 ( 或 )盆腔放置多侧孔硅胶引流管或橡皮引流管 ,术后经引流管观察有无出血、胆漏、感染等情况。 结果 术后早期大出血 3例 ,经再次手术后止血 2例 ,死亡 1例 ;胆漏 5例 ,4例引流 1～ 4个月自愈 ,1例死于感染并全身衰竭 ;并发膈下感染 3例 ,2例经局部冲洗、引流后治愈 ,1例再次手术后死于多器官功能衰竭 ;盆腔及肠腔间积液、积脓各 1例 ,再次手术治愈。 结论 外科引流在肝脏外科术后具有重要价值 ,对及时发现术后大出血、胆漏及预防膈下、肝下。

Objective To explore the clinical value of surgical drainage in hepatectomy. Methods Ninety-seven cases of liver operation during January 1992～ December 2002 were reviewed, drainage tubes had been implanted under the diaphragm, the liver and/or in the pelvic cavity during the operation in all the cases. Any presence of bleeding, bile leakage and infectious fluid was observed through the drainage tubes after the operations. Results Postoperative bleeding within the first eight hours ocurred in 3 cases, bile leakage happened in 5 cases, and subphrenic infection was found in 3 cases. There were pelvic and interintestinal space hydrops or empyema formation in 2 cases. Conclusion The surgical drainage technique in liver surgery is still of important clinical significance for monitoring the postoperative bleeding or bile seeping, and prevention of infection or fluid accumalation in the peritoneal cavity or spaces.