Early removal of prophylactic drains reduces the risk of intra-abdominal infections in patients with pancreatic head resection - Prospective study for 104 consecutive patients
Early removal of prophylactic drains reduces the risk of intra-abdominal infections in patients with pancreatic head resection - Prospective study for 104 consecutive patients
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DOI：
10.1097/01.sla.0000218077.14035.a6
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发表时间：
2006-07-01
影响因子：
9
通讯作者：
Yamaue, Hiroki
中科院分区：
文献类型：
--
作者：
Kawai, Manabit;Tani, Masaji;Yamaue, Hiroki
目的：本研究的目的是确定引流管插入时间是否影响术后并发症的发生率。背景资料：胰头切除术后预防性引流的意义仍有争议。没有报告讨论的关联期间的引流插入和术后complications.Methods：共104例连续接受胰头切除术的患者参加了这项研究。为了评估预防性引流的价值，我们将患者前瞻性地分为2组：I组于2000年1月至2002年1月进行切除（n = 52，术后第8天取出引流管）; II组于2002年2月至2004年12月进行切除（n = 52，术后第4天取出引流管）。结果：胰瘘发生率II组（3.6%）明显低于I组（23%）（P = 0.0038）。与I组（38%）相比，II组（7.7%）的腹腔内感染率（包括腹腔内脓肿和腹腔内感染性积液）显著降低（P = 0.0003）。I组52例患者中有18例（34.6%）插入引流管超过8天，而II组52例患者中只有2例（3.7%）插入引流管超过4天（P = 0.0002）。引流液培养阳性率：I组16/52例（30.8%），II组2/52例（3.7%）（P = 0.0002）。术中出血（> 1500 mL）、手术时间（>420 min）和引流管插入时间是腹腔内感染的显著危险因素（P分别为0.043、0.025、0.0003）。多因素分析显示，引流管插入时间是腹腔内感染的唯一独立危险因素（优势比为6.7）。结论：引流管拔除时间是降低胰头切除术后并发症发生率的独立因素。包括腹腔感染
Objective: The aim of this Study was designed to determine whether the period of drain insertion influences the incidence of postoperative complications.Background Data: The significance of prophylactic drains after pancreatic head resection is still controversial. No report discusses the association of the period of drain insertion and postoperative complications.Methods: A total of 104 consecutive patients who underwent pancreatic head resection were enrolled in this Study. To assess the value of prophylactic drains, we prospectively assigned the patients into 2 groups: group I underwent resection from January 2000 to January 2002 (n = 52, drain to be removed oil postoperative day 8); group II underwent resection from February 2002 to December 2004 to 52, drain to be removed oil postoperative day 4). Postoperative complications in the 2 groups were compared.Results: The rate of pancreatic fistula was significantly lower in group II (3.6%) than in group I (23%) (P = 0.0038). The rate of intraabdominal infections, including intra-abdominal abscess and infected intra-abdominal collections, was significantly reduced in group II (7.7%) compared with group I (38%) (P = 0.0003). Eighteen of 52 (34.6%) patients in group I had an inserted drain beyond 8 days, whereas only 2 of 52 (3.7%) patients in group II had all inserted drain beyond 4 days (P = 0.0002). Cultures of drainage fluid were positive in 16 of 52 (30.8%) patients in group I, and in 2 of,52 (3.7%) patients in group II (P = 0.0002). Intraoperative bleeding (> 1500 mL), operative time (>420 minutes, and the period of drain insertion were significant risk factors for intra-abdominal infections (P = 0.043, 0.025, 0.0003, respectively). The period of drain insertion was the only independent risk factor for intra-abdominal infections by multivariate analysis (odds ratio, 6.7).Conclusion: Drain removal oil postoperative day 4 was shown to be all independent factor in reducing the incidence of complications with pancreatic head resection. including, intra-abdominal infections.