右上腹腹腔外引流的误区

摘要

目的：探讨右上腹腹腔外引流的方法。方法：抽取3年来笔者所在科室收治的上腹部不同手术共967例，随机分为试验组和对照组，试验组常规Winslow孔置管，右侧腋前线肋缘下引出引流管，对照组右肝上间隙放置引流管，沿右结肠旁沟，沿腋前线与脐水平交点偏内侧2 cm处将引流管引出体外，所有病例均保证引流管不打折引出体外，最后根据不同手术类别，观察第1天引流量、拔管时间、右侧膈下积液情况、胸腔反应性积液情况等指标，对比两种引流方法的引流效果。结果：对照组第1天引流量多于试验组，对照组拔管时间短于试验组，对照组术后发生膈下积液、胸腔反应性积液少于试验组。结论：对于右上腹引流，对照组引流效果优于试验组，且对照组可有效避免右侧膈下积液及胸腔反应性积液产生及加重。%Objective:To discuss the way of the right upper quadrant external drainage.Method:We randomly selected 967 patients of general surgery which in the epigastric region,the patients were divided into test group and control group,test group which put the drainage tube in the foramen of Winslow,and lead the drainage tube out of body on the right anterior axillary line under the right costal margin,control group which put the drainage tube in the clearance of upper right hepatic,follow the right paracolic sulci,lead the drainage tube out of body on the left of the point 2 centimeter which the right anterior axillary line and umbilicus cross.Making sure that all the patients’ drainage keep traight,according to different sort of surgery,we observed drainage of the first day,the time of pull out the drainage,the effusion under the right midriff,pleural effusion,contrast the the effect of external drainage.Result:Control group drainage more than test group of first day,the time of control group pull out the drainage short of test group,the chance of the control group gain the effusion under the right midriff or pleural effusion short of test group.Conclusion:For the right upper quadrant external drainage,the effect of control group surpass test group,control group can avoid the effusion under the right midriff and pleural effusion.