Division of Surgical Oncology and Endocrine Surgery, Department of Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa.
J Surg Res. 2013 Oct;184(2):925-30. doi: 10.1016/j.jss.2013.05.092. Epub 2013 Jun 19.
Despite a growing body of literature supporting the limited use of prophylactic intra-abdominal drainage for many procedures, drain placement after pancreatic resection remains commonplace and highly controversial.
Literature available in the PubMed was systematically reviewed by searching using combinations of keywords and citations in review articles regarding prophylactic drainage after pancreatic resection, early removal of intraoperatively placed drains after pancreatic resections, and risk factors and predictive tools for pancreatic fistula.
Prospective randomized studies on prophylactic drainage after pancreaticoduodenectomy or distal pancreatectomy have not shown any benefit in decreasing pancreatic fistula, total complications, length of hospital stay, or readmission rates. Frequency of complications was significantly higher in patients receiving routine drainage. This was recently supported by retrospective studies; however, patients with risk factors for pancreatic fistula (soft pancreatic texture, prolonged operative times, and increased blood loss) were more likely to have prophylactic intra-abdominal drainage. Alternatively, if a drain is placed, prospective randomized studies demonstrate that early removal is safe in patients with postoperative day 1 drain amylase values <5000 U/L and associated with a lower rate of fistula.
The current literature supports a strategy of selective drainage and early drain removal after pancreatic resection in low-risk patients.
尽管越来越多的文献支持在许多手术中预防性使用腹腔引流，但胰腺切除术后放置引流管仍然很常见，且极具争议。
通过在 PubMed 中搜索有关胰腺切除术后预防性引流、胰腺切除术后术中放置引流管的早期移除以及胰瘘的危险因素和预测工具的综述文章中的关键词和引文，对文献进行了系统回顾。
关于胰十二指肠切除术或胰体尾切除术预防性引流的前瞻性随机研究并未显示减少胰瘘、总并发症、住院时间或再入院率的任何益处。接受常规引流的患者并发症发生率显著更高。最近的回顾性研究也支持了这一观点；然而，具有胰瘘危险因素（胰腺质地柔软、手术时间延长和失血增加）的患者更有可能预防性放置腹腔引流管。或者，如果放置引流管，前瞻性随机研究表明，对于术后第 1 天引流淀粉酶值<5000 U/L 的患者，早期移除是安全的，且与瘘管的发生率较低相关。
目前的文献支持在低风险患者中采用选择性引流和胰腺切除术后早期引流管移除的策略。
