本文選題：seldinger技術(shù) + 雙套管�。� 參考：《皖南醫(yī)學院》2017年碩士論文

【摘要】：目的:總結(jié)并探討皖南醫(yī)學院第一附屬醫(yī)院弋磯山醫(yī)院胃腸外科2012年01月至2015年12月收治的外科手術(shù)后發(fā)生腸外瘺患者應用seldinger技術(shù)置腹腔雙套管(黎氏雙套管模型)持續(xù)沖洗負壓引流在腸外瘺(enterocutaneous fistula,ECF)治療中的效果。方法:回顧性分析皖南醫(yī)學院第一附屬醫(yī)院弋磯山醫(yī)院胃腸外科2012年01月至2015年12月收治的外科手術(shù)后發(fā)生消化道腸外瘺患者,均采用seldinger技術(shù)置腹腔雙套管負壓吸引引流共計21例,其中男性13例,女性8例,年齡39-71歲,平均年齡(61.10±11.41)歲,其中胃惡性腫瘤9例,結(jié)直腸惡性腫瘤6例,胰腺惡性腫瘤2例,結(jié)腸多發(fā)性腺瘤性息肉病1例,肝癌1例,膽總管下段癌1例,胃癌合并腸癌1例,分析其自愈率,住院天數(shù),置管天數(shù),置管前后0-72h最高體溫變化(腋窩),置管前后0-72h白細胞變化,中性粒細胞百分比變化。結(jié)果:1)本組患者中5例患者經(jīng)過一段時間引流后,再手術(shù)治療,手術(shù)后治愈,2例患者自動出院,剩余14例均自愈,自愈率66.67%。置管持續(xù)時間最短5天,最長35天,平均置管時間為(17.67±9.32d),平均住院時間為(43.14±14.97d)。2)置管前后0-72h患者最高體溫變化:根據(jù)發(fā)熱程度變化將病患分為低熱組與高熱組。其中A組為經(jīng)seldinger置雙套管前0-72h體溫變化在36-37.2℃,平均值為(36.96±0.28℃),合計7例。B組為經(jīng)seldinger置雙套管前0-72h體溫變化在37.3-38.5℃,平均值為(37.84±0.41℃),合計14例。A組穿刺前與穿刺后0-72h最高體溫比較,P0.05,差異有統(tǒng)計學意義。B組穿刺前與穿刺后0-72h最高體溫比較,P0.05,差異有統(tǒng)計學意義。總計(A+B組)穿刺前與穿刺后0-72h最高體溫比較,P0.01,差異有統(tǒng)計學意義。3)置管前后0-72h白細胞及中性粒細胞百分比值變化:其中5例患者置管前白細胞(WBC)及中性粒細胞百分比(NEUT%)處于正常范圍內(nèi),記為Ⅰ組,白細胞及中性粒百分比升高的共計16例,記為Ⅱ組。Ⅰ組置管前WBC平均值為(6.72±0.37)×109/L,置管后WBC平均值為(6.98±0.55)×109/L,兩者比較,P值大于0.05,無統(tǒng)計學意義。Ⅱ組置管前WBC平均值為(12.54±3.93)×109/L,置管后WBC平均值為(9.23±3.52)×109/L,置管前后比較,P值小于0.01,差異有統(tǒng)計學意義。Ⅰ組置管前NEUT%平均值為(68.1±4.99)%,置管后NEUT%平均值為(65.16±5.93)%,兩者比較,P值大于0.05,無統(tǒng)計學意義。Ⅱ組置管前NEUT%平均值為(83.69±1.41)%,置管后WBC平均值為(78.40±6.12)%,置管前后比較,P值小于0.01,差異有統(tǒng)計學意義。結(jié)論:(1)Seldinger法置腹腔雙套管持續(xù)沖洗負壓引流在腸瘺治療中是安全有效的,并有微創(chuàng),取材方便等優(yōu)點。(2)對于伴有腹腔感染的腸外瘺患者,置雙套負壓吸引引流術(shù)后72小時內(nèi),體溫、白細胞、中細粒細胞百分比即有一定程度下降,腹腔內(nèi)環(huán)境得到較快改善。
[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 鹵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 鹵9.32 d, and the average hospitalization time was 43.14 鹵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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