开腹胆囊切除不置腹腔引流临床研究

目的　研究胆囊切除不置腹腔引流的可行性及其优缺点。方法　调查 1993年 1月至 1998年 12月共 70 1例病人。引流组 (A组 ) 2 72例 ,不引流组 (B组 ) 42 9例。均为单纯胆囊切除。A组放置烟卷引流条 (A1)或乳胶管 (A2 )引流。结果　 1.A组术后住院天数、术后发热天数均显著高于B组 (P <0 .0 1和P <0 .0 0 1) ;2 .并发症 :A组明显高于B组 (P <0 .0 1)。A组发生胆漏 2例 ,腹腔出血 1例。切口感染比B组多 (P <0 .0 1)。 4例病人因引流口感染及不闭合延迟至术后15～ 18d出院。 3 .A1组比A2组术后住院天数长、使用止痛剂次数多 (P <0 .0 1)。结论　胆囊切除常规放置腹腔引流没有必要 ;胆囊切除不置引流是安全可行的 ,但应有一定的指征 ,术者应因地制宜 ,灵活掌握。

Elective cholecystectomy with or without drainage: a clinic study

Objective To evaluate the possbility and benefits of electivecholecystectomy without drainage.Methods Patients were divided into subhepatic draining group (group A, n = 337 ) and not draining group (group B, n=364 ). There was no difference in the age or sex in the two groups. Post-operative period of fever(>37.2℃), wound infection and other complications were observed. Also postoperative hospital stay of patients was noted.Results Wound infection occurred significantly more (P< 0.01) in group A (in 12 patients) as compared with group B (in 4 patients). Postoperative bile leakage was seen in 2 patients in group A but none in group B. Patients in group A had longer post-operative period of fever and the post operative hospital stay than those in group B (P< 0.001,P < 0.01respectively ) ; There were no intraperitoneal infections in both groups .Conclusions Cholecystectomy with drainage is associated with more infective complications than that without drainage and cholecystectomy without drainage is safe .The drainage should be used only when indicated.