Is intra-abdominal drainage necessary after pancreaticoduodenectomy?
Is intra-abdominal drainage necessary after pancreaticoduodenectomy?
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DOI：
10.1016/s1091-255x(98)80077-2
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发表时间：
1998-07-01
期刊：
影响因子：
--
通讯作者：
Brennan, M F
中科院分区：
文献类型：
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作者：
Heslin, M J;Harrison, L E;Brennan, M F
理论上，胰管切除术后闭合吸引引流用于引流潜在的收集物和吻合口漏。目前尚不清楚这种引流是否有效、有害或影响手术后的结果。连续89例患者接受胰十二指肠切除术的假定壶腹周围恶性肿瘤，并进行回顾性分析。38例患者没有腹腔内引流，51例在手术结束时放置了引流管。我们分析了患者、营养、实验室和手术室因素，终点为并发症和住院时间。腹腔内并发症定义为腹腔内脓肿和胰瘘或胆瘘。术后干预定义为CT引导下引流和再次手术。通过Student t检验和卡方检验进行分析。8名外科医生中有2名对92%的患者未进行引流。两组在人口统计学、营养和手术因素方面相当。无引流组的麻醉时间显著缩短（P = 0.0001）。在瘘、脓肿、CT引流或住院时间方面没有统计学差异。腹腔内引流并没有显著改变胰管切除术后瘘、脓肿或再手术的风险或CT引导下介入的必要性。胰管切除术后常规使用引流管可能没有必要，应进行随机试验。
Closed suction drains after pancreaticoduodenectomy are theoretically used to drain potential collections and anastomotic leaks. It is unknown whether such drains are effective, harmful, or affect the outcome after this operation. Eighty-nine consecutive patients underwent pancreaticoduodenectomy for presumed periampullary malignancy and were retrospectively reviewed. Thirty-eight had no intra-abdominal drains and 51 had drains placed at the conclusion of the operation. We analyzed patient, nutritional, laboratory, and operating room factors with end points being complications and length of hospital stay. Intra-abdominal complications were defined as intra-abdominal abscess and pancreatic or biliary fistula. Postoperative interventions were defined as CT-guided drainage and reoperation. Analysis was by Student's t test and chi-square test. Two of eight surgeons contributed 92% of the patients without drains. The groups were equivalent with respect to demographic, nutritional, and operative factors. Time under anesthesia was significantly shorter in the group without drains (P = 0.0001). There was no statistical difference in the rate of fistula, abscess, CT drainage, or length of hospital stay. Intra-abdominal drainage did not significantly alter the risk of fistula, abscess, or reoperation or the necessity for CT-guided intervention after pancreaticoduodenectomy. Routine use of drains after pancreaticoduodenectomy may not be necessary and should be subjected to a randomized trial.