Shrikhande Shailesh V, Barreto Savio G, Shetty Guruprasad, Suradkar Kunal, Bodhankar Yashodhan D, Shah Sumeet B, Goel Mahesh
Department of Hepato-Pancreato-Biliary Surgical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India.
J Cancer Res Ther. 2013 Apr-Jun;9(2):267-71. doi: 10.4103/0973-1482.113380.
Traditionally, surgeons have resorted to placing drains following major gastrointestinal surgery. In recent years, the value of routine drainage has been questioned, especially in the light of their role in post-operative pain, infection, and prolonged hospital stay. The aim of this study was to compare the peri-operative outcomes following the use of a single versus two drains for gastric and pancreatic resections.
Patients undergoing resections for gastric and pancreatic malignancies were included in the study. Patients were subdivided into two groups depending on the number of drains placed, viz. one drain (Group 1) or two drains (Group 2). Clinico-pathologic outcomes were recorded and compared.
Of the 285 patients included in the analysis, group 1 consisted of 226 patients while group 2 included 59 patients. Overall, drains alerted the surgeon to existence of complications in 62% of patients - 70% in group 1 and 44.4% in group 2 (P < 0.19). The morbidity and mortality rates in groups 1 and 2 were 25.2% and 3.9%, and 23.7% and 0%, respectively (P < 0.61 and P < 0.12). There were no drain-related complications. Median hospital stay was significantly lower in group 1 (11 vs. 14 days) (P < 0.001).
The insertion of drains did aid in the detection of complications following gastric and pancreatic surgery. Two drains offer no further advantage over one drain in terms of detection of complications. While the number of drains did not contribute to, or reduce, the morbidity and mortality in the two groups, the use of one drain significantly reduced hospital stay. Taken together, these findings support the prophylactic insertion of a single intra-abdominal drain following gastric and pancreatic resections.
传统上，外科医生在进行大型胃肠道手术后会常规放置引流管。近年来，常规引流的价值受到质疑，尤其是考虑到其在术后疼痛、感染和延长住院时间方面所起的作用。本研究的目的是比较在胃和胰腺切除术中使用一根引流管与两根引流管后的围手术期结局。
纳入接受胃和胰腺恶性肿瘤切除术的患者。根据放置引流管的数量将患者分为两组，即一根引流管（第1组）或两根引流管（第2组）。记录并比较临床病理结局。
在纳入分析的285例患者中，第1组有226例患者，第2组有59例患者。总体而言，引流管使外科医生发现了62%患者的并发症——第1组为70%，第2组为44.4%（P < 0.19）。第1组和第2组的发病率和死亡率分别为25.2%和3.9%，以及23.7%和0%（P < 0.61和P < 0.12）。未出现与引流管相关的并发症。第1组的中位住院时间显著更短（11天对14天）（P < 0.001）。
放置引流管确实有助于发现胃和胰腺手术后的并发症。在发现并发症方面，两根引流管并不比一根引流管有更多优势。虽然引流管的数量对两组的发病率和死亡率没有影响或降低作用，但使用一根引流管显著缩短了住院时间。综上所述，这些发现支持在胃和胰腺切除术后预防性插入一根腹腔内引流管。
