Ruiz-Tovar Jaime, Ortega Irene, Santos Jair, Sosa Liliana, Armañanzas Laura, Diez Tabernilla María, Calero Alicia, Arroyo Antonio, Oliver Israel, García Salvador, Calpena Rafael
Servicio de Cirugía General, Hospital General Universitario de Elche, Alicante, España.
Cir Esp. 2012 May;90(5):318-21. doi: 10.1016/j.ciresp.2012.01.008. Epub 2012 Apr 5.
Classically, a sub-hepatic drain was inserted routinely in a cholecystectomy to prevent intra-abdominal abscesses, possible post-surgical bleeding, and biliary fistulas. Over the years, it has been demonstrated that the systematic use of a drain does not have any benefits, and many studies conclude that, in special circumstances (bleeding, signs of gallbladder inflammation, incidental opening, or suspected bile leak), and depending on the experience of the individual surgeon, the insertion of a drain may be of use.
[corrected] A prospective study was conducted on 100 elective laparoscopic cholecystectomies performed due to symptomatic cholelithiasis or gallbladder polyps. A sub-hepatic drain was inserted in 15 of them. The indications for inserting it were: in 11 patients as a "control" due to a gallbladder bed bleed controlled during surgery, and in 4 due to a gallbladder opening with the excretion of turbid-purulent bile. The main outcomes investigated were the clinical benefit achieved by the insertion of the drain, the hospital stay, and the quantifying of the pain by the patients 24h after surgery, using a visual analogue scale.
The insertion of a drain was of no benefit to any patient. The median hospital stay increased by 1 day in patients with a drain (P=.002). The median pain score at 24h was higher in patients with a drain inserted (P=.018).
The insertion of a sub-hepatic drain after elective laparoscopic cholecystectomy increases post-surgical pain and prolongs hospital stay, and does not prevent the occurrence of intra-abdominal abscesses.
传统上，胆囊切除术中常规插入肝下引流管以预防腹腔内脓肿、术后可能的出血和胆瘘。多年来，已证明系统性使用引流管并无任何益处，许多研究得出结论，在特殊情况下（出血、胆囊炎症迹象、意外开口或疑似胆漏），并取决于外科医生个人的经验，插入引流管可能有用。
[已修正] 对因有症状的胆结石或胆囊息肉而进行的100例择期腹腔镜胆囊切除术进行了前瞻性研究。其中15例插入了肝下引流管。插入引流管的指征为：11例患者因手术中控制的胆囊床出血作为“对照”，4例因胆囊开口并有浑浊脓性胆汁排出。主要研究结果包括插入引流管所带来的临床益处、住院时间以及术后24小时患者使用视觉模拟量表对疼痛的量化。
插入引流管对任何患者均无益处。有引流管的患者中位住院时间增加了1天（P = 0.002）。插入引流管的患者术后24小时的中位疼痛评分更高（P = 0.018）。
择期腹腔镜胆囊切除术后插入肝下引流管会增加术后疼痛并延长住院时间，且不能预防腹腔内脓肿的发生。
