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采用传统钳夹压榨技术进行肝切除术后无需腹腔引流。

Abdominal drainage was unnecessary after hepatectomy using the conventional clamp crushing technique.

作者信息

Lu Lu, Sun Hui-Chuan, Qin Lun-Xiu, Wang Lu, Ye Qin-Hai, Ren Ning, Fan Jia, Tang Zhao-You

机构信息

Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai 200032, China.

出版信息

J Gastrointest Surg. 2006 Feb;10(2):302-8. doi: 10.1016/j.gassur.2005.06.002.

Abstract

A prophylactic abdominal drainage catheter is routinely inserted by many surgeons in patients after hepatic resection. Between January 2002 and September 2004, 462 consecutive patients who had undergone hepatic resection using a clamp crushing method by the same surgical team were retrospectively divided into the drainage group (n = 357) and the nondrainage group (n = 105). There was no difference in hospital mortality between the two groups of patients (drainage group, 0.6% vs. nondrainage group, 0%; P = 1.0). However, there was a greater incidence of surgical complications in the drainage group (31.4% vs. 8.6%, P < 0.001), and greater incidence of wound complications and subphrenic complications in the drainage group compared to the nondrainage group (24.4% vs. 4.8%, P < 0.001). In addition, the mean (+/- SEM) postoperative hospital stay of the drainage group was 13 +/- 6.5 days, which was significantly longer than that of the nondrainage group (9.7 +/- 3.3 days, P = 0.001). On multivariate analysis, abdominal drainage and intraoperative bleeding were the independent risk factors that were significantly associated with the incidence of drainage-related complications. The results suggested that routine abdominal drainage is unnecessary after hepatic resection when the conventional clamp crushing method is used during parenchyma transection.

摘要

许多外科医生在肝切除术后患者中常规插入预防性腹腔引流管。在2002年1月至2004年9月期间,对同一手术团队采用钳夹挤压法进行肝切除的462例连续患者进行回顾性分析,分为引流组(n = 357)和非引流组(n = 105)。两组患者的住院死亡率无差异(引流组为0.6%,非引流组为0%;P = 1.0)。然而,引流组手术并发症的发生率更高(31.4%对8.6%,P < 0.001),与非引流组相比,引流组伤口并发症和膈下并发症的发生率更高(24.4%对4.8%,P < 0.001)。此外,引流组术后平均(±SEM)住院时间为13±6.5天,明显长于非引流组(9.7±3.3天,P = 0.001)。多因素分析显示,腹腔引流和术中出血是与引流相关并发症发生率显著相关的独立危险因素。结果表明,在实质横断术中采用传统钳夹挤压法时,肝切除术后常规腹腔引流是不必要的。

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