Bawahab Mohammed A, Abd El Maksoud Walid M, Alsareii Saeed A, Al Amri Fahad S, Ali Hala F, Nimeri Abdul Rahman, Al Amri Abdul Rahman M, Assiri Adel A, Abdul Aziz Mohammed I
General Surgery Department, Faculty of Medicine, King Khalid University, Abha 61421, Saudi Arabia;
General Surgery Department, Faculty of Medicine, Najran University, Najran, P.O. 1988, Saudi Arabia;
J Biomed Res. 2014 May;28(3):240-5. doi: 10.7555/JBR.28.20130095. Epub 2014 Apr 10.
Many surgeons practice prophylactic drainage after cholecystectomy without reliable evidence. This study was conducted to answer the question whether to drain or not to drain after cholecystectomy for acute calculous cholecystitis. A retrospective review of all patients who had cholecystectomy for acute cholecystitis in Aseer Central Hospital, Abha, Saudi Arabia, was conducted from April 2010 to April 2012. Data were extracted from hospital case files. Preoperative data included clinical presentation, routine investigations and liver function tests. Operative data included excessive adhesions, bleeding, bile leak, and drain insertion. Complicated cases such as pericholecystic collections, mucocele and empyema were also reported. Patients who needed therapeutic drainage were excluded. Postoperative data included hospital stay, volume of drained fluid, time of drain removal, and drain site problems. The study included 103 patients allocated into two groups; group A (n = 38) for patients with operative drain insertion and group B (n = 65) for patients without drain insertion. The number of patients with preoperative diagnosis of acute non-complicated cholecystitis was significantly greater in group B (80%) than group A (36.8%) (P < 0.001). Operative time was significantly longer in group A. All patients who were converted from laparoscopic to open cholecystectomy were in group A. Multivariate analysis revealed that hospital stay was significantly (P < 0.001) longer in patients with preoperative complications. There was no added benefit for prophylactic drain insertion after cholecystectomy for acute calculous cholecystitis in non-complicated or in complicated cases.
许多外科医生在没有可靠证据的情况下，在胆囊切除术后进行预防性引流。本研究旨在回答急性结石性胆囊炎胆囊切除术后是否需要引流的问题。对2010年4月至2012年4月在沙特阿拉伯阿卜哈市阿西尔中心医院接受急性胆囊炎胆囊切除术的所有患者进行了回顾性研究。数据从医院病例档案中提取。术前数据包括临床表现、常规检查和肝功能检查。手术数据包括粘连过多、出血、胆漏和引流管插入情况。还报告了复杂病例，如胆囊周围积液、黏液囊肿和积脓。需要治疗性引流的患者被排除在外。术后数据包括住院时间、引流液量、引流管拔除时间和引流部位问题。该研究纳入了103例患者，分为两组；A组（n = 38）为插入手术引流管的患者，B组（n = 65）为未插入引流管的患者。B组术前诊断为急性非复杂性胆囊炎的患者数量（80%）显著高于A组（36.8%）（P < 0.001）。A组手术时间明显更长。所有从腹腔镜胆囊切除术转为开腹胆囊切除术的患者均在A组。多因素分析显示，术前有并发症的患者住院时间显著延长（P < 0.001）。对于急性结石性胆囊炎胆囊切除术后的非复杂性或复杂性病例，预防性插入引流管没有额外益处。
