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目的:探讨胆道手术T管引流的临床观察与护理。方法:对我院2006年1月~2008年12月行胆道手术T管引流的212例患者的临床观察与护理进行总结与分析。结果:212例患者中,208例按期拔除T管治愈出院,4例患者拔除T管后发生胆漏,采取插入导尿管持续负压引流、抗感染、静脉高营养等治疗方法后治愈出院。结论:重视胆道手术T管引流的临床观察与护理,制定周密有效的术前、术后护理措施,对病情严密细致的观察,积极预防并发症的发生,是手术成功的重要保证。 相似文献
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胆道T管引流术后的观察与护理 总被引:2,自引:0,他引:2
目的:探讨胆道T管引流的术后护理方法。方法:对279例胆道探查T管引流术后患者做好管道护理,加强病情观察,预防术后并发症。结果:本组发生T管周围感染2例,T管滑脱造成胆汁漏入腹腔5例,窦道形成不全、拔管后致胆汁性腹膜炎2例,其余270例治疗效果满意。结论:加强胆道T管引流术后护理,减少并发症发生,是保证手术成功,促进患者康复的关键。 相似文献
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目的探讨经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)术后患者行胆道手术的护理要点。方法2012年1—9月共收治5例PCI术后需行胆道手术的患者,其中腹腔镜胆囊切除1例、开腹胆囊切除1例、胆囊切除加胆总管切开取石T管引流3例。结果5例患者术后恢复良好,均未发生并发症,住院天数为8~23d。3例留置T管的患者,1个月后来院顺利拔除T管。结论加强PCI术后行胆道手术患者的护理重点包括术前准备、心理护理、并存疾病的治疗及护理、术后循环系统的监测、抗凝护理、康复护理及并发症的观察和护理。 相似文献
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[目的]探讨胆道T管引流术后T管脱出的原因及其护理应对措施.[方法]回顾性分析2002 ~2009年本科发生的7例胆道术后T管脱出的原因及采取的相应护理应对措施.[结果]6例患者经原位置foley管引流和积极护理,未出现并发症;1例重新置管后胆漏患者经鼻胆管引流(ENBD)和积极护理后症状消失,所有患者均痊愈出院.[结... 相似文献
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目的:提高心脏死亡供体(DCD)肝移植手术患者术后“T”管的护理效果,减少胆道并发症的发生。方法对10例DCD肝移植手术患者术后“T”管的留置及护理方法进行回顾性分析。结果术后3个月先行“T”管照影检查后拔除“T”管,10例患者均未发生严重的胆道并发症。结论通过留置“T”管,并进行良好的“T”管护理,有效地避免及减少了胆道并发症的发生。 相似文献
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[目的]分析胆道术后发生胆漏原因,总结预防护理措施。[方法]回顾性分析15例胆道术后发生胆漏病人的临床资料。[结果]采用保守治疗及护理13例,再手术2例,均痊愈出院。[结论]胆漏多发生于胆道手术及T管拔出后,主要与肝外胆道的解剖变异、炎症、粘连等病理改变和操作不仔细有关,预防护理措施应以术后做好心理护理、T管护理和发热护理为主。严密观察病情,及时发现胆漏,认真、积极、细心地做好胆漏的护理,是治愈胆道术后发生胆漏的关键因素。 相似文献
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胆结石感染菌群与术后T型管护理的临床研究 总被引:2,自引:0,他引:2
目的了解广西地区胆结石感染患者胆汁不同致病菌与术后T管引流量、引流液颜色及拔管时间的关系,探讨术后护理方法。方法回顾性分析2008年10月~2010年9月我院住院并手术的100例胆结石感染患者,根据术中胆汁培养结果分为G+菌组和G-菌组。对两组患者术后T管引流液量、颜色、拔管时间进行分析。结果两组术后T管引流量及引流液颜色比较无统计学意义;G+菌组术后拔T管时间早于G-菌组(P<0.05)。结论胆道感染不同致病菌与术后拔T管时间有一定的关系;胆汁引流量和引流液颜色对于胆道感染菌群鉴别有待加大样本量进行更深入的研究。 相似文献
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Biliary Tract Excretion of Cefazolin, Cephalothin, and Cephaloridine in the Presence of Biliary Tract Disease
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Kenneth R. Ratzan Carlos Ruiz George L. Irvin III 《Antimicrobial agents and chemotherapy》1974,6(4):426-431
The biliary tract excretion of three cephalosporins, cefazolin, cephaloridine, and cephalothin, was compared in patients with biliary tract disease. In the absence of obstruction, mean antibiotic levels in bile from gall bladder and common duct in patients undergoing cholecystectomy were highest for cefazolin (17 and 31 mug/ml, respectively) than either cephaloridine (7 and 9 mug/ml) or cephalothin (1 and 4 mug/ml). Biliary tract levels generally paralleled serum levels. In no patient with cystic duct obstruction were any of the cephalosporins detectable in appreciable amounts in gall bladder bile. In patients with T-tube drainage given each of the three different cephalosporins on separate days, concentrations of cefazolin in bile were many-fold higher than either cephaloridine or cephalothin. Peak levels of cefazolin in T-tube bile averaged 51 mug/ml after intravenous and 26 mug/ml after intramuscular administration, whereas mean peak levels of cephalothin and cephaloridine were only 6 and 16 mug/ml, respectively. Here, too, T-tube levels reflected serum concentrations and obstruction to biliary flow impaired excretion of each of the drugs. 相似文献
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Peter F. Hahn M.D. Ph.D. Mark J. Girard Stuart G. Silverman Bruce Forman Glenn Tung Peter R. Mueller 《Abdominal imaging》1989,14(1):238-240
For patients with high biliary obstruction drained by a T-tube, achieving internal drainage requires special techniques. Modification of a method described by Sammon for common bile duct obstruction permits placement of a biliary endoprosthesis astride the T-tube tract. The key step is traction exerted downward on the endoprosthesis by a suture passing through a second catheter temporarily inserted into the common bile duct. A case is described in which the technique has been applied successfully. 相似文献
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The biliary excretion of aztreonam was studied in 10 post-cholecystectomy patients with T-tube biliary drainage (group A) and four other subjects with obstructive biliary tract disease who had recent placement of external biliary drainage (group B). Maximum biliary levels ranged from 9.7 to 88.2 micrograms/ml (mean, 42.9 +/- 7.9 micrograms/ml) and occurred 2.4 h after injection of a single 1-g dose intravenously. Peak biliary levels observed in group B patients were approximately one-third those in group A. Cumulative 12-h biliary excretion (group B) accounted for 0.18 +/- 0.06% of the total dose. In the same period, urinary excretion accounted for 65 to 72% of the total dose. The lower biliary levels of aztreonam observed in group B patients relative to those in group A suggest that in patients with total biliary tract obstruction the liver may not recover full secretory capacity, at least within 3 to 7 days after biliary decompression. 相似文献
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目的探讨双腔T管窦道造影预防拔管后胆漏的临床疗效并总结护理要点。方法将125例患者随机分为2组,63例患者实行胆道T管外引流,拔T管前经双腔T管窦道胆道造影(治疗组),62例患者采用常规置管.拔管前行非窦道胆道造影(对照组)。两组患者均采取包括心理护理在内的多种护理措施,比较两组平均拔管时间和并发症发生率。结果对照组患者平均拔管时间为36.2d。拔T管后发生胆漏6例,占9.68%;治疗组患者平均拔管时间为16.2d;拔管后2例发生胆漏,占3.17%;治疗组的拔管时间与胆漏发生率均明显低于对照组,两组比较具有统计学差异(均P〈0.05)。结论拔T管前经双腔T管窦道胆道造影可客观地反映窦道的形成情况,同时辅以合理的护理,可有效地防止拔管后胆漏的发生,值得临床推广应用。 相似文献
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目的:探讨胆石症再次手术的原因及预防措施。方法:对我院过去5年收治的134例胆石症再次手术病例的临床资料进行回顾性分析。结果:胆石症再次手术主要原因为结石残留或复发(86.57%),医源性胆管损伤(4.48%),拔除T管后胆汁性腹膜炎(4.48%),残留胆囊炎伴结石(2.99%),胆肠吻合口狭窄伴结石(1.49%)等。再次手术方式以胆总管切开取石胆道镜检查取石"T"形管引流术、胆总管十二指肠侧侧吻合术,肝胆管-空肠Roux-en-Y吻合术,肝叶段切除,残留胆囊切除术为主。本组患者痊愈131例,死亡3例,死亡率2.29%,术后残石率5.17%。结论:对于胆石症,无论是首次手术还是多次手术,均应做好术前检查,制定周密的手术计划,利用胆道外科和肝脏外科技术,努力贯彻去除病灶,解除梗阻,通畅引流三原则,力争将残石率、复发率、再手术率降低到最低限度。 相似文献
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Biliary concentrations of a new cephalosporin, ceftizoxime, were measured in bile collected in 8 cholecystectomized patients provided with T-tube drainage and in 14 patients where bile was obtained by puncture of the gall bladder and choledochus during cholecystectomy. In patients with external biliary drainage, a mean biliary peak of 150.3 +/- SEM 49.8 micrograms/ml has been observed 2 h after intravenous injection of 2 g of ceftizoxime; the antibiotic activity amounted still to 17.3 +/- 6.0 micrograms/ml after 6 h. Assays performed during operation showed the following simultaneous concentrations 1 h after 2 g of ceftizoxime given intravenously: serum: 85.3 +/- 8.1 micrograms/ml; main duct bile: 279.8 +/- 40.0 micrograms/ml; gallbladder bile: 119.9 +/- 19.4 micrograms/ml. These findings were compared with the biliary excretion of 8 other cephalosporins studied previously under the same conditions. The results of the present study suggest that administration of ceftizoxime may be effective in the treatment of biliary tract infections. 相似文献
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目的 探讨腹腔镜联合术中十二指肠镜同步治疗胆囊结石合并急性胆道梗阻的临床治疗效果.方法 实验组:30例胆囊结石合并急性胆道梗阻患者采用腹腔镜联合术中十二指肠镜同步治疗,对照组:30例同类患者行传统开腹胆囊切除+胆总管切开(胆道镜)取石+T管引流术;对两组患者手术时间,术后胃肠道恢复时间,所需总治疗时间,术后并发症(胆漏、胆道结石残留、胆道感染)发生情况进行统计分析.结果 在整个治疗过程中,实验组所需治疗时间明显小于对照组,术后出现胆道结石残留、胆道感染情况,两组差异有显著性(P<0.05).结论 采用腹腔镜联合术中十二指肠镜同步法治疗胆囊结石合并急性胆道梗阻住院时间短、恢复快、术后并发症少,有推广普及价值. 相似文献
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目的:总结多肝段月牙形切除肝断面空肠内引流治疗高位恶性胆道梗阻的临床护理经验。方法:对27例行多肝段月牙形切除肝断面空肠内引流术的高位恶性胆道梗阻的患者,术前做好心理疏导和各项手术准备,术后做好生命体征的观察、并发症的观察及预防、引流管的护理等措施。结果:27例患者中术后两周黄疸明显减轻17例,完全消失10例,并发应激性溃疡出血12例,经及时治疗及护理后痊愈出院。无死亡病例。结论:对多肝段月牙形切除肝断面空肠内引流手术后患者进行及时细致的护理是减少并发症、提高手术成功率的重要措施。 相似文献
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不同方式的腹腔镜胆道探查术治疗胆总管结石的临床前瞻性研究 总被引:15,自引:6,他引:15
目的通过比较分析腹腔镜下经胆囊管和经胆总管切开T管引流及胆管一期缝合胆道镜取石治疗胆囊结石继发胆总管结石病人的疗效,以评价各种腹腔镜胆道探查方式治疗胆总管结石的临床价值。方法自2000年1月 ̄2003年6月根据4项筛选标准,对符合条件的61例病人按胆道探查途径不同分为经胆囊管组(n=14)和胆总管切开组,后者又分为胆总管一期缝合组(n=23)和T管引流组(n=24)。比较观察3组病例的手术时间、腹腔引流时间、术后住院日、恢复正常工作时间、术后平均输液量、住院费用、手术并发症及术后随访结果。结果经胆囊管组手术时间明显短于一期缝合组和T管引流组(P<0.05),T管引流组腹腔引流时间、术后住院日、恢复正常工作时间、术后平均输液量、住院费用明显长于或高于经胆囊管组和一期缝合组(P<0.05),而经胆囊管组和一期缝合组除手术时间外其他指标无明显差异(P>0.05)。经胆囊管组出现手术并发症1例(7.1%),一期缝合组出现手术并发症3例(13.0%),均为胆道并发症;T管引流组出现手术并发症7例(29.2%),其中胆道并发症5例(20.8%)。3组患者随访结果无明显差异。结论经胆囊管途径的腹腔镜胆道探查术治疗适合的胆囊结石继发胆总管结石病人的疗效优于胆管切开途径的腹腔镜胆道探查术,而后者中胆管一期缝合的疗效又明显优与T管引流。 相似文献