Yui Rintaro, Satoi Sohei, Toyokawa Hideyoshi, Yanagimoto Hiroaki, Yamamoto Tomohisa, Hirooka Satoshi, Yamaki So, Ryota Hironori, Michiura Taku, Inoue Kentaro, Matsui Yoichi, Kwon A-Hon
Department of Surgery, Kansai Medical University, 2-3-1 Shin-machi, Hirakata, Osaka, 573-1191, Japan.
J Hepatobiliary Pancreat Sci. 2014 Jan;21(1):72-7. doi: 10.1002/jhbp.4. Epub 2013 Jun 27.
The aim of this study was to retrospectively compare morbidity and mortality before and after introduction of a new departmental policy for patients who undergo distal pancreatectomy.
We have introduced the use of an ultrasonically-activated device in distal pancreatectomy, an "early removal of drains" policy and perioperative management using a clinical pathway since May 2006. Group A consisted of 52 consecutive patients from 2000 to February 2006. Group B consisted of 57 consecutive patients from May 2006 to 2010.
Although there was no difference in the fluid collection rate within 30 postoperative days (Group A, 44% vs. Group B, 35%), the rates of intra-abdominal abscess (A, 19% vs. B, 4%) and grade 3/4 of the Clavien classification (A, 23% vs. B, 9%) in Group B were significantly lower than in Group A (P < 0.05). Time of drain removal (median 3 days vs. 8 days) and length of in-hospital stay (median 8 days vs. 17 days) in Group B were significantly shorter than in Group A (P < 0.001).
The implementation of new departmental guidelines for distal pancreatectomy was closely associated with a low frequency of intra-abdominal abscess and grade 3/4 Clavien score, resulting in a shorter in-hospital stay.
本研究的目的是回顾性比较针对接受胰体尾切除术患者引入新科室政策前后的发病率和死亡率。
自2006年5月起，我们在胰体尾切除术中引入了超声激活设备的使用、“早期拔除引流管”政策以及采用临床路径的围手术期管理。A组由2000年至2006年2月期间连续的52例患者组成。B组由2006年5月至2010年期间连续的57例患者组成。
尽管术后30天内的积液发生率无差异（A组为44%，B组为35%），但B组的腹腔内脓肿发生率（A组为19%，B组为4%）和Clavien分类3/4级发生率（A组为23%，B组为9%）显著低于A组（P<0.05）。B组的引流管拔除时间（中位数3天对8天）和住院时间（中位数8天对17天）显著短于A组（P<0.001）。
胰体尾切除术新科室指南的实施与腹腔内脓肿的低发生率和Clavien评分3/4级密切相关，从而缩短了住院时间。
