腹腔引流对日间腹腔镜胆囊切除术患者的临床疗效分析

Abdominal drainage versus no abdominal drainage for patients undergoing day-surgery laparoscopic cholecystectomy

  • 摘要: 目的 分析腹腔引流对日间腹腔镜胆囊切除术(day surgery laparoscopic cholecystectomy,LC/DS)患者的应用价值。 方法 回顾性分析我院2009年11月- 2017年1月159例行LC/DS+置管引流术(试验组)及162例行LC/DS(对照组)患者的临床资料,比较两组手术时间、术中出血量、术后并发症、30 d再入院率、住院时间、腹腔引流量、置管时间等。 结果 除性别外,两组患者基线资料差异无统计学意义。试验组与对照组的手术时间110.00(75.00,140.00) min vs 102.50(94.75,117.90) min,P=0.769和术中出血量20.00(10.00,50.00) ml vs 20.00(10.00,35.00) ml,P=0.224差异无统计学意义,而术后住院时间2.00(2.00,3.00) d vs 1.00(1.00,1.00) d,P=0.000和术后并发症发生率(30.19% vs 9.88%,P=0.000)试验组均高于对照组且有统计学差异;试验组与对照组的术中情况结果无差异(P=0.199);试验组术中情况不同时腹腔置管时间及总引流量有统计学差异(P=0.000;P=0.006)。 结论 LC/DS应用腹腔引流时术后并发症发生率较高,尤其是引流管周围腹痛,因此LC/DS不必常规应用腹腔引流,但是胆囊与周围粘连严重并发慢性炎性反应行胆囊大部切除时,LC/DS可以考虑使用腹腔引流,对预防腹水及感染和及早发现术后胆漏及出血具有一定作用。

     

    Abstract: Objective To analyze the clinical effect of abdominal drainage for patients undergoing day-surgery laparoscopic cholecystectomy (LC/DS). Methods Clinical data about 159 patients undergoing abdominal drainage in LC/DS (study group) and 162 patient simply undergoing LC/DS (control group) in our hospital from November 2009 to January 2017 were retrospectively analyzed.The operating time, blood loss, postoperative complications, readmission rate, hospital stay, abdominal drainage volume, drainage time and other information were collected and analyzed, the clinical effect of two groups was compared. Results There was no significant difference in general data between two groups, except for gender. The operating time 110.00 (75.00, 140.00) min vs 102.50 (94.75, 117.90) min, P=0.769 and blood loss 20.00 (10.00, 50.00) ml vs 20.00 (10.00, 35.00) ml, P=0.224 were not significantly different between two groups, but the postoperative hospitalization 2.00(2.00, 3.00) d vs 1.00(1.00, 1.00) d, P=0.000 and postoperative complications rate (30.19% vs 9.88%, P=0.000) were significantly higher in the study group compared with control group. In the study group, there were significant differences in the drainage time and total drainage volume between mild adhesion (MA), severe adhesion (SA), severe adhesion plus acute inflammation (SA & AI) groups (all P< 0.01), the drainage time and total drainage volume were significantly higher in the SA and (SA & AI) groups compared with the MA group (all P< 0.01). Conclusion Postoperative complications occur frequently when adopting abdominal drainage after LC/DS, especially abdominal pain around the drainage tube. It's not necessary to use abdominal drainage in LC/DS when there is no special indication or mild adhesion surrounding gallbladder. However, it is recommended when there is severe adhesion or acute inflammation surrounding gallbladder.

     

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