腹腔引流管拔除困難的原因分析及處理方法（附22例報道）_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 何賢祿 , 劉偉

核工業四一六醫院普外科（四川成都 610051）;

Corresponding?author：

Keywords：

腹腔引流; 腹腔引流管; 腹部手術

DOI：

10.7507/1007-9424.20160130

Video：

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目的探討腹腔引流管拔除困難的原因及臨床處理方法。方法回顧性分析筆者所在醫院2003年7月至2015年5月期間22例腹部手術后腹腔引流管拔除困難患者的臨床資料，總結分析其原因及處理方法。結果本組患者中引流管拔除時間為術后4～7 d者6例，7～10 d者16例。引流管拔除困難的原因1例為固定引流管的縫線從引流管穿過，4例為腹壁戳孔偏小，2例為引流管扭曲，9例為組織嵌入引流管內口或引流管側孔（其中5例為纖維條索，4例為大網膜），6例無法確定原因。5例通過持續均勻用力牽引拔除，1例拆除縫合固定線拔除，8例通過旋轉、來回牽拉或推送引流管拔除，8例應用持續重力牽引法拔除，無并發副損傷。結論靈活應用各種方法來處理難以拔除的引流管，持續重力牽引法適宜于常規方法不能拔除的引流管。減少不必要的引流管放置，放置引流管時注意其細節和及時拔除引流管可避免引流管的拔除困難。

Citation： 何賢祿, 劉偉. 腹腔引流管拔除困難的原因分析及處理方法（附22例報道）. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2016, 23(4): 490-492. doi: 10.7507/1007-9424.20160130 Copy

1.	伍曉汀, 周勇.腹腔引流管的正確選擇和合理應用.中國實用外科雜志, 2005, 25(1):35-36.
2.	鄭志剛.組織嵌入腹腔引流管致拔管困難9例.中國實用外科雜志, 2002, 22(8):483.
3.	Carlomagno N, Santangelo M, Grassia S, et al. Laparoscopic retrieval of retained intraperitoneal drain in the immediate postoperative period Report of two cases. Ann Ital Chir, 2012, 23:2012.
4.	Burt BM, Brown K, Jarnagin W, et al. An audit of results of a no-drainage practice policy after hepatectomy. Am J Surg, 2002, 184(5):441-445.
5.	Khurrum Baig M, Hua Zhao R, Batista O, et al. Percutaneous posto perative intra-abdominal abscess drainage after elective colorectal surgery. Tech Coloproctol, 2002, 6(3):159-164.
6.	Hirahara N, Matsubara T, Hayashi H, et al. Significance of proph ylactic intra-abdominal drain placement after laparoscopic distal gastrectomy for gastric cancer. World J Surg Oncol, 2015, 12(13):181-187.
7.	Albanopoulos K, Alevizos L, Linardoutsos D, et al. Routine abdo minal drains after laparoscopic sleeve gastrectomy:a retrospective review of 353 patients. Obes Surg, 2011, 21(6):687-691.
8.	莊榮華, 孫育海, 葉慶衡.持續牽引法處理腹腔引流管拔管困難11例.河北醫藥, 2004, 26(1):25-26.
9.	李永杰, 劉莉, 周耿, 等.腹腔鏡膽囊切除術后是否腹腔引流隨機對照試驗的Meta分析.世界華人消化雜志, 2014, 22(27):4162-4167.
10.	Park JS, Kim JH, Kim JK, et al. The role of abdominal drainage to prevent of intra-abdominal complications after laparoscopic cholecystectomy for acute cholecystitis:prospective randomized trial. Surg Endosc, 2015, 29(2):453-457.
11.	Liu HP, Zhang YC, Zhang YL, et al. Drain versus no-drain after gastrectomy for patients with advanced gastric cancer:systematic review and meta-analysis. Dig Surg, 2011, 28(3):178-189.
12.	汪東文, 樊巍巍, 宋軍, 等.結腸癌根治切除術預防性放置腹腔引流管隨機對照研究.中國普通外科雜志, 2010, 19(10):1129-1131.
13.	Puleo FJ, Mishra N, Hall JF. Use of intra-abdominal drains. Clin Colon Rectal Surg, 2013, 26(3):174-177.
14.	Galandiuk S. To drain or not drain. Ann Surg, 2005, 241(1):14-15.
15.	Kawai M, Tani M, Terasawa H, et al. Early removal of prophylactic drains reduces the risk of intra-abdomoinal infection in patients with pancreatic head resection:prospective study for 104 consecutive patients. Ann Surg, 2006, 244(1):1-7.

1. 伍曉汀, 周勇.腹腔引流管的正確選擇和合理應用.中國實用外科雜志, 2005, 25(1):35-36.
2. 鄭志剛.組織嵌入腹腔引流管致拔管困難9例.中國實用外科雜志, 2002, 22(8):483.
3. Carlomagno N, Santangelo M, Grassia S, et al. Laparoscopic retrieval of retained intraperitoneal drain in the immediate postoperative period Report of two cases. Ann Ital Chir, 2012, 23:2012.
4. Burt BM, Brown K, Jarnagin W, et al. An audit of results of a no-drainage practice policy after hepatectomy. Am J Surg, 2002, 184(5):441-445.
5. Khurrum Baig M, Hua Zhao R, Batista O, et al. Percutaneous posto perative intra-abdominal abscess drainage after elective colorectal surgery. Tech Coloproctol, 2002, 6(3):159-164.
6. Hirahara N, Matsubara T, Hayashi H, et al. Significance of proph ylactic intra-abdominal drain placement after laparoscopic distal gastrectomy for gastric cancer. World J Surg Oncol, 2015, 12(13):181-187.
7. Albanopoulos K, Alevizos L, Linardoutsos D, et al. Routine abdo minal drains after laparoscopic sleeve gastrectomy:a retrospective review of 353 patients. Obes Surg, 2011, 21(6):687-691.
8. 莊榮華, 孫育海, 葉慶衡.持續牽引法處理腹腔引流管拔管困難11例.河北醫藥, 2004, 26(1):25-26.
9. 李永杰, 劉莉, 周耿, 等.腹腔鏡膽囊切除術后是否腹腔引流隨機對照試驗的Meta分析.世界華人消化雜志, 2014, 22(27):4162-4167.
10. Park JS, Kim JH, Kim JK, et al. The role of abdominal drainage to prevent of intra-abdominal complications after laparoscopic cholecystectomy for acute cholecystitis:prospective randomized trial. Surg Endosc, 2015, 29(2):453-457.
11. Liu HP, Zhang YC, Zhang YL, et al. Drain versus no-drain after gastrectomy for patients with advanced gastric cancer:systematic review and meta-analysis. Dig Surg, 2011, 28(3):178-189.
12. 汪東文, 樊巍巍, 宋軍, 等.結腸癌根治切除術預防性放置腹腔引流管隨機對照研究.中國普通外科雜志, 2010, 19(10):1129-1131.
13. Puleo FJ, Mishra N, Hall JF. Use of intra-abdominal drains. Clin Colon Rectal Surg, 2013, 26(3):174-177.
14. Galandiuk S. To drain or not drain. Ann Surg, 2005, 241(1):14-15.
15. Kawai M, Tani M, Terasawa H, et al. Early removal of prophylactic drains reduces the risk of intra-abdomoinal infection in patients with pancreatic head resection:prospective study for 104 consecutive patients. Ann Surg, 2006, 244(1):1-7.

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腹腔引流管拔除困難的原因分析及處理方法（附22例報道）

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