摘要
目的 探讨良性胆道疾病T管拔除后致胆汁性腹膜炎的原因及处理措施。方法 回顾性分析 19例T管拔除后胆汁性腹膜炎的处理过程及再次手术术中所见。结果 19例患者中 ,常规拔T管 15例 ,误拔T管 4例。 3例非手术治疗痊愈 ,其余 16例手术治疗。术中发现包括误拔T管 4例在内的 5例瘘道形成缺如 ,4例瘘道形成不完整 ,1例胆总管撕裂。再次手术病例 ,术后 1例死于中毒性休克 ,15例痊愈。结论 T管瘘道形成缺如或不完整及误拔T管、拔管损伤是拔T管后胆汁性腹膜炎的重要原因。根据腹部体征及全身情况 ,决定治疗方法。非手术治疗如无效 ,应积极手术治疗。
Objective To investigate the cause and countermeasure of biliary peritonitis after removal of T tube in patients with benign diseases of biliary tract.Methods The treatment and findings during operation in 19 cases of biliary peritonitis resulting from removal of T tube were analyzed retrospectively.Results Of 19 cases,T tubes in 15 cases was pulled out routinely and in 4 cases were pulled out in error.Three cases of biliary peritonitis resulting from routine removal of T tubes were cured by conservative treatment, and the remaining 16 patients were treated surgically.It was found no fistulous tract was formed in 5 cases intraoperatively (including 4 cases of biliary peritonitis resulting from T tube pulled out in error).Fistulous tract was not formed completely in 4 cases.Common bile duct of 1 case was lacerated.One patient was died from toxic shock postoperatively,and 15 cases were cured.Conclusion Biliary peritonitis resulting from removal of T tube is contributed to the following causes:the defect of fistulous tract formation,removal of T tube in error,the injury of fistulous tract and common bile duct.According to the occurrence and development of abdominal pain,treatments were chosen.Operation should be performed if there is not any effect by conservative treatment.
出处
《临床外科杂志》
2004年第7期424-425,共2页
Journal of Clinical Surgery
