腹腔引流管拔除困难的原因分析及处理方法（附22例报道）_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 何贤禄 , 刘伟

核工业四一六医院普外科（四川成都 610051）;

Corresponding author：

Keywords：

腹腔引流; 腹腔引流管; 腹部手术

DOI：

10.7507/1007-9424.20160130

Video：

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目的探讨腹腔引流管拔除困难的原因及临床处理方法。方法回顾性分析笔者所在医院2003年7月至2015年5月期间22例腹部手术后腹腔引流管拔除困难患者的临床资料，总结分析其原因及处理方法。结果本组患者中引流管拔除时间为术后4～7 d者6例，7～10 d者16例。引流管拔除困难的原因1例为固定引流管的缝线从引流管穿过，4例为腹壁戳孔偏小，2例为引流管扭曲，9例为组织嵌入引流管内口或引流管侧孔（其中5例为纤维条索，4例为大网膜），6例无法确定原因。5例通过持续均匀用力牵引拔除，1例拆除缝合固定线拔除，8例通过旋转、来回牵拉或推送引流管拔除，8例应用持续重力牵引法拔除，无并发副损伤。结论灵活应用各种方法来处理难以拔除的引流管，持续重力牵引法适宜于常规方法不能拔除的引流管。减少不必要的引流管放置，放置引流管时注意其细节和及时拔除引流管可避免引流管的拔除困难。

Citation： 何贤禄, 刘伟. 腹腔引流管拔除困难的原因分析及处理方法（附22例报道）. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2016, 23(4): 490-492. doi: 10.7507/1007-9424.20160130 Copy

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2.	郑志刚.组织嵌入腹腔引流管致拔管困难9例.中国实用外科杂志, 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.	庄荣华, 孙育海, 叶庆衡.持续牵引法处理腹腔引流管拔管困难11例.河北医药, 2004, 26(1):25-26.
9.	李永杰, 刘莉, 周耿, 等.腹腔镜胆囊切除术后是否腹腔引流随机对照试验的Meta分析.世界华人消化杂志, 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.	汪东文, 樊巍巍, 宋军, 等.结肠癌根治切除术预防性放置腹腔引流管随机对照研究.中国普通外科杂志, 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. 伍晓汀, 周勇.腹腔引流管的正确选择和合理应用.中国实用外科杂志, 2005, 25(1):35-36.
2. 郑志刚.组织嵌入腹腔引流管致拔管困难9例.中国实用外科杂志, 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. 庄荣华, 孙育海, 叶庆衡.持续牵引法处理腹腔引流管拔管困难11例.河北医药, 2004, 26(1):25-26.
9. 李永杰, 刘莉, 周耿, 等.腹腔镜胆囊切除术后是否腹腔引流随机对照试验的Meta分析.世界华人消化杂志, 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. 汪东文, 樊巍巍, 宋军, 等.结肠癌根治切除术预防性放置腹腔引流管随机对照研究.中国普通外科杂志, 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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腹腔引流管拔除困难的原因分析及处理方法（附22例报道）

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