T管拔除后胆漏的预防

The prophylaxis of symptomatic bile leakage after removal of T-tubes from the common bile duct

目的 探讨拔T管后出现胆漏并发症的预防。方法 胆总管探查、T管引流术的连续病例 2 4 3例。A组 114例术后 3周拔T管 ,若出现有症状胆漏和 /或胆汁性腹膜炎 ,立即用红橡皮导尿管置入窦道作引流 1～ 6d(平均 3.5d)。B组 12 9例术后 2周拔T管后常规立即用红橡皮导尿管置入窦道作引流 1～ 4d(平均 1.5d)。结果 A组拔T管后发生胆漏 9例 ,B组无胆漏发生。所有病例均获治愈出院。两组胆漏发生率有显著性差异 (χ2 =8.4 9,P <0 .0 0 5 )。结论 拔管后再引流法可有效预防拔T管后胆漏的发生。对已发生的局限性胆汁性腹膜炎 ,及时用导尿管置入窦道作引流 。

Objective To explore the prophylaxis of symptomatic bile leakage and/or bile peritonitis following the removal of T tubes from the common bile duct. Methods A retrospective study was carried out in 243 consecutive patients with T tube drainage after exploration of the common bile duct. The T tubes were removed in third week postoperatively in group 1 (114 cases). If bile leakage occurred, a rubber Nelaton's catheter was reset into the sinus tract to drain for 1～6 days ( 3.5 days, average). In group 2 (129 cases), Nelaton's catheters were regularly reset immediately after T tubes removal in second week postoperatively. There were 9 cases of bile leakage in group 1, but no bile leakage occurred in group 2. All had an uneventful course. Statistic analysis showed that the incidence of bile leakage between two groups was significantly different (χ 2= 8.49 , P < 0.005 ). Conclusion Resetting a Nelaton's catheter into the sinus track immediately following extubation can effectively prevent the symptomatic bile leakage after T tube removal. Inserting a Nelaton's catheter into the sinus tract to drain is also an effective treatment for local bile peritonitis that has occurred.