Keighley M R, Burdon D W, Baddeley R M, Dorricott N J, Oates G D, Watts G T, Alexander-Williams J
Br J Surg. 1976 Oct;63(10):754-8. doi: 10.1002/bjs.1800631007.
The complications of elective choledochotomy in a prospective study of 116 patients with suspected intraduct calculi are reported. Management included T tube drainage (n = 59), primary closure of the bile duct (n = 29) and choledochoduodenostomy (n = 28). Septicaemia occurred in 12 patients (10%), with 1 death, and was unrelated to the type of operation. Thirty patients (26%) developed wound infection; this complication was more common after T tube drainage than the other procedures. Intra-abdominal abscess occurred in 3 patients only. Thrombo-embolism was recorded in 10 patients (9%), 7 of whom had an intraduct drain. Postoperative pancreatitis occurred in 5 patients (4%), with 2 deaths; a third of the patients in whom sphincteroplasty had been combined with supraduodenal choledochotomy developed this complication. Reoperation for stones was required in 3 patients with T tube; 3 patients developed a temporary biliary fistula after choledochoduodenostomy. The hospital stay was 9-5 days after primary closure, 14-0 days after choledochoduodenostomy and 16-8 days after T tube drainage. Wound sepsis (32%) and thrombo-embolism (12%) were more common in patients with bacterbilia than in patients where the bile was sterile at operation (13 and 3% respectively). Furthermore, wound sepsis, septicaemia and thrombo-embolism were reduced in patients who were given effective antibiotic cover.
本文报告了一项针对116例疑似胆管结石患者的前瞻性研究中择期胆总管切开术的并发症情况。治疗方法包括T管引流（n = 59）、胆管一期缝合（n = 29）和胆总管十二指肠吻合术（n = 28）。12例患者（10%）发生败血症，其中1例死亡，败血症与手术方式无关。30例患者（26%）发生伤口感染；该并发症在T管引流术后比其他手术更为常见。仅3例患者发生腹腔内脓肿。10例患者（9%）记录有血栓栓塞，其中7例有胆管引流。5例患者（4%）发生术后胰腺炎，2例死亡；三分之一接受括约肌成形术联合十二指肠上段胆总管切开术的患者发生了该并发症。3例T管引流患者因结石需要再次手术；3例胆总管十二指肠吻合术后出现暂时性胆瘘。胆管一期缝合术后住院时间为9.5天，胆总管十二指肠吻合术后为14.0天，T管引流术后为16.8天。有菌血症的患者伤口感染（32%）和血栓栓塞（12%）比术中胆汁无菌的患者更常见（分别为13%和3%）。此外，接受有效抗生素覆盖的患者伤口感染、败血症和血栓栓塞发生率降低。
