PTCD治疗术后胆漏2例
Medical Journal of National Defending Forces in Southwest China(2020)
Abstract
病例1女,71岁,因“反复右上腹疼痛伴寒战、发热1年余”入院.既往有3次胆道手术病史.10年前曾在我科行左半肝切除、胆肠吻合术.入院诊断:肝胆管结石并胆管炎;左半肝切除术后;胆肠吻合术后.经积极术前准备,行胆管切开取石、胆肠吻合.术后第5d,因剧烈咳嗽,腹腔压力突然升高,出现胆肠吻合口胆漏,漏口位于吻合口前侧壁,吻合口后方引流管未能良好引流胆汁,胆汁从切口流出,胆汁漏量较大,每日约有300 ml,切口持续吸引但3d后引流量不见减少,且出现发热等胆管炎症状,体温最高达到39.2℃.为解决胆漏,减少漏量,治疗胆管炎,采用经皮经肝胆道穿刺引流术(PTCD)技术,将胆汁外引,减少胆肠吻合口胆汁量,从而为减少胆汁漏量,促进瘘口愈合.在B超引导下,行局部麻醉,结合术前CT及MRI影像学资料,顺利穿刺右肝管并置入猪尾巴管,置入引流管长度为15 cm.PTCD术后,胆汁顺利引出,术后1h内,胆肠吻合口几乎无胆汁漏出,且未再出现胆管炎.PTCD引流管引流胆汁量每日约500~600 ml,引流1 w后造影见吻合口愈合,夹闭猪尾巴管,未出现胆漏、胆管炎,完全治愈.
MoreAI Read Science
Must-Reading Tree
Example
![](https://originalfileserver.aminer.cn/sys/aminer/pubs/mrt_preview.jpeg)
Generate MRT to find the research sequence of this paper
Chat Paper
Summary is being generated by the instructions you defined