Routine drainage of the operative bed following elective distal pancreatectomy does not reduce the occurrence of complications.
Routine drainage of the operative bed following elective distal pancreatectomy does not reduce the occurrence of complications.
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DOI：
10.1007/s11605-014-2608-z
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发表时间：
2015-01
期刊：
影响因子：
--
通讯作者：
Pitt HA
中科院分区：
文献类型：
--
作者：
Behrman SW;Zarzaur BL;Parmar A;Riall TS;Hall BL;Pitt HA
择期胰腺切除术后手术区域的常规引流仍存在争议。关于远端胰腺切除术（DP）的特定数据尚未在多机构合作中进行研究。
利用了美国外科医师学会 - 国家外科质量改进计划胰腺切除示范项目的数据。分析了引流管放置对胰腺切除相关并发症及总体发病率的影响。计算了引流管放置的倾向评分，并使用最近邻匹配法创建了一个匹配队列。使用双变量和逻辑回归分析对各组进行了比较。
在14个多月的时间里，累计有761例患者接受了远端胰腺切除术；其中606例放置了引流管。116例患者可进行倾向评分匹配。引流组和非引流组在多个术前和术中变量方面没有差异。所有胰瘘（p<0.01）和总体发病率（p<0.05）在放置引流管的患者中更为常见。放置引流管并没有降低临床相关胰瘘的发生率，也没有减少术后操作的需求。
择期远端胰腺切除术后放置引流管与更高的总体发病率和胰瘘发生率相关。引流管并没有降低腹腔内感染性并发症的发生率、临床相关胰瘘的发生率，也没有减少术后治疗干预的需求。
Routine drainage of the operative bed following elective pancreatectomy remains controversial. Data specific to distal pancreatectomy (DP) have not been examined in a multi-institutional collaborative. Data from the American College of Surgeons-National Surgical Quality Improvement Program Pancreatectomy Demonstration Project were utilized. The impact of drain placement on development of pancreatectomy-related and overall morbidity were analyzed. Propensity scores for drain placement were calculated, and nearest neighbor matching was used to create a matched cohort. Groups were compared using bivariate and logistic regression analyses. Over 14 months, 761 patients undergoing DP were accrued; 606 were drained. Propensity score matching was possible in 116 patients. Drain and no drain groups were not different with respect to multiple preoperative and operative variables. All pancreatic fistulas (p<0.01) and overall morbidity (p<0.05) were more common in patients who received a drain. The placement of a drain did not reduce the incidence of clinically relevant pancreatic fistula nor the need for postoperative procedures. Placement of drains following elective distal pancreatectomy was associated with a higher overall morbidity and pancreatic fistulas. Drains did not reduce intra-abdominal septic morbidity, clinically relevant pancreatic fistulas nor the need for postoperative therapeutic intervention.
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影响因子：
9
作者：
Correa-Gallego C;Brennan MF;Dʼangelica M;Fong Y;Dematteo RP;Kingham TP;Jarnagin WR;Allen PJ
通讯作者：
Allen PJ
影响因子：
2.9
作者：
Pitt, Henry A.;Kilbane, Molly;Mulvihill, Sean J.
通讯作者：
Mulvihill, Sean J.
影响因子：
3
作者：
Paulus, Elena M.;Zarzaur, Ben L.;Behrman, Stephen W.
通讯作者：
Behrman, Stephen W.
影响因子：
9
作者：
Kawai, Manabit;Tani, Masaji;Yamaue, Hiroki
通讯作者：
Yamaue, Hiroki
DOI：
10.1016/s1091-255x(98)80077-2
发表时间：
1998-07-01
期刊：
Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract
影响因子：
--
作者：
Heslin, M J;Harrison, L E;Brennan, M F
通讯作者：
Brennan, M F