摘要
目的比较肝右叶切除患者术后不同引流方式的效果。方法前瞻性纳入2017年4月至2018年2月复旦大学附属中山医院90例行肝右叶切除患者,男性74例,女性16例。按照随机数字表法分成乳胶管组、硅胶管组、联合组,各30例。乳胶管组于右膈下放置乳胶管接引流袋;硅胶管组于右膈下放置硅胶管接负压球吸引;联合组于右膈下放置乳胶管接引流袋,同时肝脏手术创面旁放置硅胶管接负压球。观察和比较手术区积液、术后并发症、肝功能、术后住院天数等指标。结果三组男女比例、年龄、肝硬化、手术切除范围、术中出血量等比较,差异无统计学意义(P>0.05)。乳胶管组发生并发症6例(20.0%),硅胶管组7例(23.3%),联合组5例(16.7%),三组术后并发症发生率比较差异无统计学意义(P>0.05)。乳胶管组、硅胶管组以及联合组手术区积液分别为19例(63.3%)、16例(53.3%)及5例(16.7%)。联合组术后积液发生率显著低于其他两组,差异有统计学意义(P<0.05)。三组术后发热率、总胆红素、ALT及住院时间等比较,差异无统计学意义(P>0.05)。结论肝肿瘤行肝右叶切除术后放置乳胶管接引流袋和硅胶管接负压球可减少术后膈下积液发生率,对术后积液感染有一定的预防作用。同时不影响术后肝功能恢复及住院天数,未增加术后感染。
Objective To compare different drainage methods after right hepatectomy. Methods From April 2017 to February 2018, 90 patients who underwent right hepatectomy at Zhongshan Hospital of Fudan University were prospectively randomized to the latex tube group (right subphrenic drain with a latex tube connecting to a collection bag, n=30), the silicone tube group (right subphrenic drain with a silicone tube connecting to a closed-suction, n=30) or the combination group (right subphrenic drain with a latex tub, combined with a silicone tube, n=30). The amount of fluid collection after the operation, complications after surgery, recovery of liver function, and length of hospital stay after operation were compared. Results There were no significant differences in the clinicopathological features among the 3 groups, including gender, age, cirrhosis status, extent of hepatectomy, and blood loss (P>0.05). There were no significant differences among the three groups on the incidences of postoperative complications [the latex tube group, 20.0%(6/30);the silicone tube group, 23.3%(7/30);the combination group, 16.7%(5/30);P>0.05]. Ultrasonography showed significantly lower rates of subphrenic collection in the combination group compared with the latex tube group and the silicone tube group [16.7%(5/30) vs. 63.3%(19/30) vs. 53.3%(16/30);P<0.05]. The rates of postoperative fever, serum total bilirubin, ALT and postoperative hospital stay were similar among the three groups (P>0.05). Conclusions Drainage using the combination of a latex tube connecting to a collection bag and a silicone tube connecting to closed-suction after right hepatectomy significantly reduced postoperatively subphrenic collection and prevented infection of the collection. However, the treatment strategy did not delay liver function recovery, prolong hospital stay nor increase post-operative infection rate.
作者
易勇
刘高
尹毅锐
孙健
黄成
刘卫仁
邱双健
Yi Yong;Liu Gao;Yin Yirui;Sun Jian;Huang Cheng;Liu Weiren;Qiu Shuangjian(Department of Liver Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China)
出处
《中华肝胆外科杂志》
CAS
CSCD
北大核心
2019年第7期497-500,共4页
Chinese Journal of Hepatobiliary Surgery
关键词
肝切除术
引流术
手术后并发症
Hepatectomy
Drainage
Postoperative complication
