Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama 236-0004, Japan.
Surg Today. 2013 Apr;43(4):372-80. doi: 10.1007/s00595-012-0254-1. Epub 2012 Jul 14.
Although many studies have concluded that prophylactic drain insertion during elective liver resection offers few advantages, we reassessed the clinical value and appropriate management of drain insertion.
We retrospectively studied the clinical value of abdominal drainage in 167 consecutive patients who underwent hepatectomy, focusing on drainage volumes, bilirubin concentrations, drainage fluid bacterial culture results and short-term postoperative outcomes. The results were then validated prospectively in the next 50 consecutive patients to undergo hepatectomy.
Most of the patients with morbidities such as biliary fistulas, ascites, fluid collection or duodenal perforation (20/24 or 83 %) were treated using operative drainage tubes, avoiding the use of percutaneous drainage procedures. The values obtained with the formula (drainage fluid bilirubin concentration/serum bilirubin concentration) × drainage fluid volume, were greater on both postoperative days (POD) 2 and 3 (P = 0.03 and P < 0.01) in patients with biliary leakage compared with those observed in the patients without leakage. The bacteriologic cultures of drainage fluid were positive less frequently on POD 4 or earlier (7/203) than on POD 5 or later (24/74, P < 0.01). In the validation cohort, new drain removal criteria based on the retrospective results led to successful drain management without additional treatment in 96 % of patients.
Abdominal drainage is effective for both postoperative monitoring and morbidity treatment.
尽管许多研究已经得出结论，预防性引流管插入在择期肝切除术中几乎没有优势，但我们重新评估了引流管插入的临床价值和适当管理。
我们回顾性研究了 167 例连续接受肝切除术患者的腹部引流的临床价值，重点关注引流体积、胆红素浓度、引流液细菌培养结果和短期术后结果。然后在接下来的 50 例连续接受肝切除术的患者中前瞻性验证这些结果。
大多数有并发症的患者（如胆瘘、腹水、积液或十二指肠穿孔，20/24 例或 83%）通过手术引流管治疗，避免了经皮引流程序的使用。与无渗漏患者相比，在术后第 2 天和第 3 天（P=0.03 和 P<0.01），有胆漏的患者的公式（引流液胆红素浓度/血清胆红素浓度）×引流液体积的值更大。引流液的细菌培养在第 4 天或更早（7/203）时比第 5 天或更晚（24/74，P<0.01）时更常为阳性。在验证队列中，基于回顾性结果的新引流管移除标准导致 96%的患者无需额外治疗即可成功进行引流管管理。
腹部引流对于术后监测和治疗并发症都有效。
