Kapoor V K, Ibrarullah M, Baijal S S, Kulshreshtha A, Mittal B R, Saxena R, Das B K, Kaushik S P
Department of Surgical Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.
World J Surg. 1993 Jan-Feb;17(1):101-4. doi: 10.1007/BF01655718.
Eighty patients undergoing cholecystectomy were either assigned deliberately (n = 30) or randomized (n = 50) to drainage (n = 38) or nondrainage (n = 42). Subhepatic collections were seen on ultrasonography (US) after 48 to 72 hours in 12 of 35 patients with drainage and 24 of 42 patients without drainage (p < 0.05). Only two patients with subhepatic collections were symptomatic, and none required treatment. Postoperative infective complications were seen in 13 of 38 patients with drainage and with a collection, and none of the 18 patients without drainage and without a collection had postoperative infective complications (p < 0.05). Cholecystectomy was then performed in 100 patients without using a drain. BULIDA radioisotope scans revealed a bile leak in only 4 of 34 patients studied. Subhepatic collections were seen on US after 48 to 72 hours in 42 patients. The collection resolved in 22 patients and was smaller in 6 on repeat US. None of the patients with collection was symptomatic, and none required treatment. Postoperative infective complications were seen in 7 of 42 patients with a collection and 5 of 58 patients without a collection (not significant). We conclude that (1) cholecystectomy with drainage is associated with more infective complications than when a drain is not used; (2) cholecystectomy without drainage is safe; and (3) asymptomatic nonbilious subhepatic collections are common after cholecystectomy without drainage but do not require treatment, resolving spontaneously.
80例行胆囊切除术的患者被有意分配（n = 30）或随机分组（n = 50），分别接受引流（n = 38）或不引流（n = 42）。在48至72小时后，35例接受引流的患者中有12例、42例未接受引流的患者中有24例在超声检查（US）中发现肝下积液（p < 0.05）。仅有2例肝下积液患者出现症状，均无需治疗。38例接受引流且有积液的患者中有13例发生术后感染性并发症，18例未接受引流且无积液的患者均未发生术后感染性并发症（p < 0.05）。随后对100例患者未放置引流管进行胆囊切除术。BULIDA放射性核素扫描显示，在34例接受检查的患者中仅4例有胆漏。48至72小时后，42例患者在超声检查中发现肝下积液。22例患者的积液自行吸收，6例患者复查超声时积液缩小。所有有积液的患者均无症状，均无需治疗。42例有积液的患者中有7例、58例无积液的患者中有5例发生术后感染性并发症（差异无统计学意义）。我们得出结论：（1）与不放置引流管相比，放置引流管的胆囊切除术与更多的感染性并发症相关；（2）不放置引流管的胆囊切除术是安全的；（3）不放置引流管的胆囊切除术后，无症状的非胆汁性肝下积液很常见，但无需治疗，可自行吸收。
