Watanabe Fumiaki, Noda Hiroshi, Kamiyama Hidenori, Kato Takaharu, Kakizawa Nao, Ichida Kosuke, Toyama Nobuyuki, Konishi Fumio
Department of Surgery, Saitama Medical Center, Saitama, Japan.
Hepatogastroenterology. 2012 Jun;59(116):1270-3. doi: 10.5754/hge12060.
BACKGROUND/AIMS: Intra-abdominal infection (IAI) after pancreaticoduodenectomy (PD) is a common cause of prolongation of postoperative hospital stay and readmission to the hospital following discharge.
Two hundred and six patients undergoing PD were reviewed to investigate the risk factors for IAI after PD. Patients were separated into two groups: those who developed IAI after PD (Group A; n=44), and those who had not developed IAI after PD (Group B; n=162), the two groups were then compared to identify the risk factors for IAI after PD. A hundred and six patients (51.5%) underwent preoperative biliary drainage (PBD).
Multivariate analysis revealed that pancreatic fistula (PF) was an independent risk factor for IAI after PD (p<0.001; odds ratio=9.58; 95% confidence interval=4.37-21.0), but PBD was not a significant risk factor.
We demonstrated that the adequate PBD might not affect IAI after PD. On the other hand, PF was an independent risk factor for IAI after PD. A large randomized controlled trial, which would prove the effect of early removal of a prophylactic placed drain to prevent IAI, should be planned.
背景/目的：胰十二指肠切除术后腹腔内感染（IAI）是术后住院时间延长和出院后再次入院的常见原因。
回顾206例行胰十二指肠切除术的患者，以调查胰十二指肠切除术后IAI的危险因素。患者分为两组：胰十二指肠切除术后发生IAI的患者（A组；n = 44）和胰十二指肠切除术后未发生IAI的患者（B组；n = 162），然后比较两组以确定胰十二指肠切除术后IAI的危险因素。106例患者（51.5%）接受了术前胆道引流（PBD）。
多因素分析显示，胰瘘（PF）是胰十二指肠切除术后IAI的独立危险因素（p < 0.001；比值比 = 9.58；95%置信区间 = 4.37 - 21.0），但PBD不是显著危险因素。
我们证明了适当的PBD可能不会影响胰十二指肠切除术后的IAI。另一方面，PF是胰十二指肠切除术后IAI的独立危险因素。应计划开展一项大型随机对照试验，以证明早期拔除预防性放置的引流管预防IAI的效果。
