Sica G S, Spiratou C, Sileri P, Lirosi F, Gentileschi P, Rossi P, Stolfi V M, Di Lorenzo N, Russo F, Forlini A, Gaspari A L
Cattedra di Chirurgia Generale, Università degli Studi di Roma Tor Vergata.
Ann Ital Chir. 2000 May-Jun;71(3):367-72.
Although the use of drains is common in clinical practice, its real role in the prophylaxis and therapy of postoperative complications is still not clear. In the literature we can find both supporters of drains, and many opponents who consider their use unnecessary and sometimes even dangerous. In fact, during new experimental and clinical studies, it was impossible to determine the usefulness of prophylactic abdominal drain, at least in the case of colo-rectal anastomosis, it has been demonstrated that use of drains limits the risks of an anastomotic leakage but, in some cases, the same drains could be the cause of some of the complications that should be avoided. Although there is a considerable theoretical and practical evidences in favour of drainage, the dispute about "to drain or not to drain" the peritoneal cavity after elective colo-rectal surgery remains open. This retrospective study made on 150 patients operated on elective surgery for rectal cancer demonstrates that prophylactic drain does not significantly influence the general rate of leakage (3.15% for group A and 5.45% for group B, p > 0.1); in two of the three fistulas in patients with drains, the drains have permitted the diagnosis, but have not permitted the reduction of the number of operations for fistulas.
尽管引流管在临床实践中使用普遍,但其在预防和治疗术后并发症方面的实际作用仍不明确。在文献中,我们既能找到引流管的支持者,也有许多反对者,他们认为使用引流管没有必要,甚至有时是危险的。事实上,在新的实验和临床研究中,无法确定预防性腹部引流管的作用,至少在结直肠吻合术的情况下,已证明使用引流管可降低吻合口漏的风险,但在某些情况下,同样的引流管可能是一些应避免的并发症的原因。尽管有大量理论和实践证据支持引流,但关于择期结直肠手术后是否对腹腔进行“引流”的争议仍然存在。这项对150例行择期直肠癌手术患者的回顾性研究表明,预防性引流管对总体漏出率没有显著影响(A组为3.15%,B组为5.45%,p>0.1);在有引流管的患者发生的三例瘘管中的两例中,引流管有助于诊断,但并未减少瘘管手术的次数。