目的：比较肝胆手术后两种腹腔引流管的应用效果。方法：将我院2005年5月～2007年3月间行肝脏手术病人106例随机分为实验组(57例)和对照组（49例），实验组采用自制双套管持续负压冲洗引流，对照组采用传统的单腔腹腔引流管引流，分析、比较两组引流的疗效。结果：采用双套管负压冲洗引流的病人发生引流管堵塞3例，隔下感染及积液4例，采用传统的单腔腹腔引流管引流的病人发生引流管堵塞12例，隔下感染及积液15例，差异有统计学意义（Ｐ＜0.05）。结论：肝脏手术后应用双套管持续负压冲洗引流在防止引流管堵塞、隔下感染疗效优于传统的单腔腹腔引流管引流。
目的:观察持续腹腔引流治疗顽固性腹水的疗效。方法:将顽固性腹水患者74例分为两组,治疗组38例,采用腹腔置管,持续腹腔引流腹水,3000mL/天;对照组36例,以常规补充白蛋白、限钠、限水、利尿治疗为主,比较两组的疗效。观察治疗组治疗前后患者尿量、腹围和体重变化,并比较治疗组与对照组在肝、肾功能及电解质的变化及总体疗效。结果:治疗组疗效优于对照组(Plt;0.05),与治疗前比较,治疗组治疗后尿量、腹围、体重有明显改变(Plt;0.01), 肝、肾功能及电解质与对照组比较无明显变化(Pgt;0.05)。结论:持续腹腔引流治疗顽固性腹水经济适用,不良反应少,患者依从性好。
目的 探讨肠外瘘并腹腔感染的诊治。方法 回顾性分析我院2002年1月至2007年12月期间收治的86例肠外瘘并腹腔感染患者的临床资料。结果 所有肠瘘多在术后1~2周发生，经口服或引流管注入60%泛影葡胺60～100 ml造影后明确诊断，均行腹腔引流液细菌培养，加强抗感染。20例患者行腹腔冲洗引流，62例在B型超声定位下穿刺引流，4例急诊行剖腹冲洗引流，其中2例行降结肠造瘘。2例合并糖尿病的患者因全身感染严重且反复发作，出现多器官功能衰竭，分别于术后第15 天和第28 天死亡。其余84例住院治疗时间平均12 d，均顺利出院。结论 对肠外瘘并腹腔感染的患者，早期彻底的腹腔冲洗及有效的腹腔和脓肿引流，是控制感染、治愈肠外瘘的关键。
【Abstract】ObjectiveTo study the therapeutic effects of indwelling catheters in patients with severe acute pancreatitis (SAP). MethodsThe clinical data of 113 patients with severe acute pancreatitis admitted to our hospital from Aug. 2002 to May 2004 were collected. The patients were divided into the indwelling catheter group (45 cases) and the control group (68 cases).The APACHEⅡscores and therapeutic results were compared. The drainage and intraabdominal pressure (IPA) were monitored. Results The APACHEⅡscores on day 2 and day 5 after therapy in indwelling catheter group were significantly decreased compared with the control group(P=0.000).The average hospital stay and cyst morbidity of the indwelling catheter group were significantly decreased compared with those of the control group(P=0.000). The mortality rate was lower in the indwelling catheter group, but there was no statistical difference between these two groups(Pgt;0.05). The IAP was positively correlative with the drainage volume, hospital day and APACHEⅡscores(r=0.552, r=0.748, r=0.923，P=0.000). ConclusionThe indwelling catheter is an important treatment in patients with SAP.
Objective To investigate the appropriate indication about removing abdominal drainage after pancreaticoduodenectomy. Method The clinical data of 156 patients who underwent pancreaticoduodenectomy in our hospital from January 2014 to June 2016 were analyzed retrospectively. The patients were divided into two groups, with 76 patients in the enhanced recovery after surgery (ERAS) group and 80 patients in the control group according to the type of indications about removing abdominal drainage. The time of removing abdominal drainage, hospital stay, incidence of postoperative complications, and readmission rate during 30 days after surgery were compared between the2 groups. Results Compared with the control group, the time of removing abdominal drainage 〔(6.2±2.5) dvs. (10.8±2.2) d,P<0.001〕and hospital stay〔(11.8±3.4) dvs. (15.7±3.6) d,P<0.001〕 of the ERAS group were both shorter, incidence of abdominal infection was lower〔1.3% (1/76)vs. 10.0% (8/80), P=0.020〕 , but there was no significant difference in the incidence of postoperative pancreatic fistula 〔18.4% (14/76) vs. 21.3% (17/80)〕 , delayed gastric emptying〔1.4% (1/76) vs. 7.5% (6/80)〕 , and the readmission rate during 30 days after surgery〔5.3% (4/76) vs. 3.8% (3/80)〕 , P>0.05. Conclusions Indications about removing abdominal drainage after pancreaticoduodenectomy by authors are safe.
ObjectiveTo investigate predictive value of amylase level in intraperitoneal drainage fluid after pancreaticoduodenectomy (PD) for grade B and C pancreatic fistula (PF).MethodThe clinical data of 106 patients underwent PD in the First Affiliated Hospital of Xinjiang Medical University from June 2014 to June 2018 were retrospectively analyzed.ResultsTwenty-four cases (22.6%) had the PF after the PD, in which of 18 cases of grade A, 4 cases of grade B, and 2 cases of grade C. The age, tumor diameter, pancreatic texture, and main pancreatic duct diameter were associated with the PF after the PD by the univariate analysis (P<0.050), the main pancreatic duct diameter (OR=4.856, P=0.004) was its independent risk factor. The amylase levels of intraperitoneal drainage fluid on day 5, 7, and 10 after the PD could better predict the occurrence of PF (AUC was 0.910, 0.951, 0.948, respectively), especially which on day 10 after the PD could better predict the occurrence of grade B and C PF (AUC was 0.938).ConclusionElevated amylase levels in peritoneal drainage fluid on day 5, 7, and 10 after PD have better diagnostic effects on PF, especially which on day 10 after PD has a better diagnostic effect on grade B and C PF.
ObjectiveTo evaluate the safety and efficacy of unconventional abdominal drainage after laparoscopic hepatectomy.MethodsThe clinicopathologic data of patients who underwent laparoscopic hepatectomy for liver tumors in the Mianyang Central Hospital from June to December 2019 and met the inclusion criteria were retrospectively collected. Based on whether drainage tube was placed in the abdominal cavity during operation, the patients were divided into non-catheterized group (without drainage tube) and catheterized group (with drainage tube). The intraoperative data and postoperative complications (e.g. intraabdominal hemorrhage, bile leakage, abdominal infection, and liver failure) were compared between the two groups. Then, the intraoperative data and postoperative conditions of liver cancer and non-liver cancer patients with or without abdominal drainage tube were compared and analyzed.ResultsA total of 117 eligible patients were included in the study. The non-catheterized group had 59 patients and the catheterized group had 58 patients. The patients with liver cancer had 84 patients (44 non-catheterized patients and 40 catheterized patients) and the patients without liver cancer had 33 patients (15 non-catheterized patients and 18 catheterized patients). ① On the whole, the groups were comparable in the baseline data between the non-catheterized group and the catheterized group, such as gender, age, HBV infection, body mass index, hepatic function index, liver stiffness value, disease category, etc. (P>0.05). Compared with the catheterized group, the non-catheterized group had earlier off-bed activities and earlier flatus time (P<0.001), and shorter postoperative hospital stay (P=0.030). However, no statistically significant differences were found in other indicators between the two groups (P>0.05). ② Whether the patients had liver cancer or not, the non-catheterized patients still had earlier off-bed activities and earlier flatus time as compared with the catheterized patients (P<0.001). Among the patients with liver cancer, no difference was found in postoperative hospital stay. However, among the patients without liver cancer, the non-catheterized patients had shorter postoperative hospital stay than the catheterized patients (P=0.042). No statistically significant differences were found in other indicators between the catheterized patients and non-catheterized patients (P>0.05).ConclusionFor technologically skilled laparoscopic hepatectomy center, selectively not placing peritoneal drainage tube after surgery might better promote the health of patients.