Seldinger技术置腹腔双套管引流在肠外瘘治疗中的应用

发布时间：2018-05-12 13:01

  本文选题：seldinger技术 + 双套管　； 参考：《皖南医学院》2017年硕士论文

【摘要】：目的:总结并探讨皖南医学院第一附属医院弋矶山医院胃肠外科2012年01月至2015年12月收治的外科手术后发生肠外瘘患者应用seldinger技术置腹腔双套管(黎氏双套管模型)持续冲洗负压引流在肠外瘘(enterocutaneous fistula,ECF)治疗中的效果。方法:回顾性分析皖南医学院第一附属医院弋矶山医院胃肠外科2012年01月至2015年12月收治的外科手术后发生消化道肠外瘘患者,均采用seldinger技术置腹腔双套管负压吸引引流共计21例,其中男性13例,女性8例,年龄39-71岁,平均年龄(61.10±11.41)岁,其中胃恶性肿瘤9例,结直肠恶性肿瘤6例,胰腺恶性肿瘤2例,结肠多发性腺瘤性息肉病1例,肝癌1例,胆总管下段癌1例,胃癌合并肠癌1例,分析其自愈率,住院天数,置管天数,置管前后0-72h最高体温变化(腋窝),置管前后0-72h白细胞变化,中性粒细胞百分比变化。结果:1)本组患者中5例患者经过一段时间引流后,再手术治疗,手术后治愈,2例患者自动出院,剩余14例均自愈,自愈率66.67%。置管持续时间最短5天,最长35天,平均置管时间为(17.67±9.32d),平均住院时间为(43.14±14.97d)。2)置管前后0-72h患者最高体温变化:根据发热程度变化将病患分为低热组与高热组。其中A组为经seldinger置双套管前0-72h体温变化在36-37.2℃,平均值为(36.96±0.28℃),合计7例。B组为经seldinger置双套管前0-72h体温变化在37.3-38.5℃,平均值为(37.84±0.41℃),合计14例。A组穿刺前与穿刺后0-72h最高体温比较,P0.05,差异有统计学意义。B组穿刺前与穿刺后0-72h最高体温比较,P0.05,差异有统计学意义。总计(A+B组)穿刺前与穿刺后0-72h最高体温比较,P0.01,差异有统计学意义。3)置管前后0-72h白细胞及中性粒细胞百分比值变化:其中5例患者置管前白细胞(WBC)及中性粒细胞百分比(NEUT%)处于正常范围内,记为Ⅰ组,白细胞及中性粒百分比升高的共计16例,记为Ⅱ组。Ⅰ组置管前WBC平均值为(6.72±0.37)×109/L,置管后WBC平均值为(6.98±0.55)×109/L,两者比较,P值大于0.05,无统计学意义。Ⅱ组置管前WBC平均值为(12.54±3.93)×109/L,置管后WBC平均值为(9.23±3.52)×109/L,置管前后比较,P值小于0.01,差异有统计学意义。Ⅰ组置管前NEUT%平均值为(68.1±4.99)%,置管后NEUT%平均值为(65.16±5.93)%,两者比较,P值大于0.05,无统计学意义。Ⅱ组置管前NEUT%平均值为(83.69±1.41)%,置管后WBC平均值为(78.40±6.12)%,置管前后比较,P值小于0.01,差异有统计学意义。结论:(1)Seldinger法置腹腔双套管持续冲洗负压引流在肠瘘治疗中是安全有效的,并有微创,取材方便等优点。(2)对于伴有腹腔感染的肠外瘘患者,置双套负压吸引引流术后72小时内,体温、白细胞、中细粒细胞百分比即有一定程度下降,腹腔内环境得到较快改善。
[Abstract]:Objective: to summarize and discuss the application of seldinger technique in patients with intestinal fistula after surgical operation in Gastrointestinal surgery of Yiji Shan Hospital, the first affiliated Hospital of Southern Anhui Medical College, from January 2012 to December 2015, using seldinger technique to place double cannula in abdominal cavity (Li's double cannula model). The effect of continuous flushing negative pressure drainage in the treatment of enterocutanous stulla (ECF). Methods: the gastrointestinal fistula patients who were treated in the first affiliated Hospital of Southern Anhui Medical College from January 2012 to December 2015 were analyzed retrospectively. A total of 21 cases (male 13, female 8, age 39-71, mean age 61.10 卤11.41) were treated with seldinger technique, including 9 cases of gastric malignant tumor, 6 cases of colorectal malignant tumor and 2 cases of pancreatic malignant tumor. One case of multiple adenomatous polyposis of colon, one case of liver cancer, one case of carcinoma of lower common bile duct, one case of gastric carcinoma and one case of intestinal carcinoma. The rate of self-healing, the days of hospitalization and the days of tube placement were analyzed. The highest body temperature was changed from 0 to 72 hours before and after catheterization (axillary neutrophil percentage and leukocyte change within 0 to 72 hours before and after catheterization. Results (1) after drainage for a period of time, 2 cases were cured and discharged automatically. The rest 14 cases recovered themselves, and the rate of self-healing was 66.67%. The duration of catheterization was the shortest 5 days, the longest 35 days, the average time of tube insertion was 17.67 卤9.32 d, and the average hospitalization time was 43.14 卤14.97 d-1 路2) the highest body temperature of the patients was divided into low fever group and high fever group according to the change of fever degree. The body temperature of group A was 36-37.2 鈩，

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