Operative drainage following pancreatic resection: analysis of 1122 patients resected over 5 years at a single institution.
Operative drainage following pancreatic resection: analysis of 1122 patients resected over 5 years at a single institution.
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DOI：
10.1097/sla.0b013e3182813806
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发表时间：
2013-12
影响因子：
9
通讯作者：
Allen PJ
中科院分区：
文献类型：
--
作者：
Correa-Gallego C;Brennan MF;Dʼangelica M;Fong Y;Dematteo RP;Kingham TP;Jarnagin WR;Allen PJ
大约10年前，我们机构发表了唯一一项评估胰腺切除术后腹腔引流使用情况的前瞻性随机试验。当前的研究试图评估过去5年实践的演变情况。
2006年6月至2011年6月期间，共进行了1122例切除术。将6名外科医生平均分组，并根据操作模式进行比较：常规引流组（放置引流管比例>95%）、选择性引流组和常规不引流组（放置引流管比例约15%）。对前瞻性记录的术前、术中和发病情况数据在单变量和多变量模型中进行评估。
我们的手术引流率为49%，且随时间下降（2006 - 2008年为62%，2009 - 2011年为37%，P < 0.001）。未放置手术引流管的患者总体≥3级发病率显著更低（26%对33%；P = 0.01），住院时间更短（7天对8天；P < 0.01），再入院率更低（20%对27%；P = 0.01），≥3级胰瘘发生率更低（16%对20%；P = 0.05）。两组的再次手术率（均<1%）、介入放射学操作率（15%对19%；P = 0.1）和死亡率（2%对1%；P = 0.3）相似。常规引流组（n = 248）和不引流组（n = 478）在≥3级瘘或需要介入放射学引导操作方面没有差异。
在这项研究中，手术引流的使用接近一半的时间，且与更长的住院时间、更高的≥3级发病率、瘘和再入院率相关。它们没有减少再次干预的需要，也没有改变死亡率。胰腺切除术后常规预防性引流可以安全地放弃。
The only prospective randomized trial evaluating the use of intraperitoneal drainage following pancreatic resection was published from our institution approximately 10 years ago. The current study sought to evaluate the evolution of practice over the last 5 years. Between June 2006 and June 2011, there were 1122 resections performed. Six surgeons were evenly grouped and compared by practice pattern: routine drainers (drains placed > 95%), selective drainers, and routine nondrainers (drains placed ∼15%). Prospectively recorded preoperative, operative, and morbidity data were assessed in uni- and multivariate models. Our operative drainage rate was 49% and decreased over time (62% 2006–2008 vs 37% 2009–2011, P < 0.001). Patients without operative drains had significantly lower grade ≥3 overall morbidity (26% vs 33%; P = 0.01), shorter hospital stays (7 vs 8 days; P < 0.01), fewer readmissions (20% vs 27%; P = 0.01), and lower rates of grade ≥3 pancreatic fistula (16% vs 20%; P = 0.05). Similar reoperation (both <1%), interventional radiology procedures (15% vs 19%; P = 0.1), and mortality rates (2% vs 1%; P = 0.3) were seen in both groups. There were no differences between the routine drainers group (n = 248) and the nondrainers group (n = 478) in grade ≥3 fistula or need for interventional radiology-guided procedures. In this study, operative drains were used nearly half of the time and were associated with longer hospital stay, and higher grade ≥3 morbidity, fistula, and readmission rates. They did not decrease the need for reintervention or alter mortality rates. Routine prophylactic drainage after pancreatic resection could be safely abandoned.