Mullins R J, Stone H H, Dunlop W E, Strom P R
South Med J. 1985 Mar;78(3):259-61.
Routine drainage of liver wounds created by trauma has recently been challenged, prompting a prospective, randomized trial of drainage via a Penrose dam versus no drain in patients having emergency laparotomy for abdominal trauma. We excluded cases in which definite bile leak was noted at operation. Of 167 patients studied, six had obligatory drainage because of obvious bile leak. Among the remaining 161 patients, there was no significant difference as to demographics, mode of injury, volume of blood lost or used for resuscitation, incidence and severity of shock, number and types of associated injuries, or magnitude of liver wound between the 78 allocated to drainage and the 83 left without a drain. Resultant mortality, duration of hospitalization, incidence of wound and/or intra-abdominal infection, and likelihood of subsequent bile fistula were not different. Such data support the routine use of a drain only if bile leakage from the liver wound is found at laparotomy. Without obvious bile leak, drainage of a specific liver injury does not appear to be necessary.
近期，创伤所致肝损伤的常规引流受到质疑，这促使我们开展了一项前瞻性随机试验，比较在因腹部创伤行急诊剖腹手术的患者中，经橡皮引流管引流与不放置引流管的效果。我们排除了术中发现明确胆汁漏的病例。在研究的167例患者中，6例因明显胆汁漏而必须进行引流。在其余161例患者中，78例接受引流，83例未放置引流管，两组在人口统计学特征、损伤方式、失血量或用于复苏的血量、休克的发生率和严重程度、合并损伤的数量和类型，或肝损伤程度方面均无显著差异。两组的死亡率、住院时间、伤口和/或腹腔内感染的发生率以及随后发生胆瘘的可能性均无差异。这些数据表明，仅在剖腹手术中发现肝伤口有胆汁漏时才常规使用引流管。若无明显胆汁漏，特定肝损伤似乎无需引流。
