Peyronnet Benoit, Pradère Benjamin, De La Taille Alexandre, Bruyère Franck, Doumerc Nicolas, Droupy Stéphane, Vaessen Christophe, Baumert Hervé, Bernhard Jean-Christophe, Rouprêt Morgan, Mejean Arnaud, Bensalah Karim
Department of Urology, University of Rennes, 2 rue Henri Le Guilloux, 35000, Rennes, France.
Department of Urology, University of Tours, Tours, France.
World J Urol. 2016 Jul;34(7):933-8. doi: 10.1007/s00345-015-1721-2. Epub 2015 Oct 28.
We aimed to assess the impact of a postoperative drainage after RPN.
A retrospective multicentric study included RPN performed at eight centers between 2010 and 2014. Three centers stopped using postoperative drainage early in their RPN experience, whereas other institutions systematically left a drain. Preoperative characteristics, complication rates, need for postoperative imaging or procedure (surgical or radiological) and length of hospital stay were compared between the two groups [drainage (D) and no drainage (ND)].
Among 636 RPNs, 140 were done without drainage (22 %). In the ND group, surgeons were more experienced (>50 cases: 55.7 vs. 15.1 %; p < 0.0001), and tumors were more complex (RENAL score: 7.6 vs. 6.5; p < 0.0001). Complication rates were similar in both groups (21.9 vs. 20.2 %; p = 0.67). The omission of postoperative drainage did not increase requirement of CT scan (RR = 1.03; 95 % CI 0.64-1.67). Length of hospital stay was shorter in the ND group (4.5 vs. 5.5 days; p = 0.007). There were six urinary fistulas: four in the D group (0.8 %) and two in the ND group (1.4 %; p = 0.49). A CT scan was done to confirm the diagnosis of fistula in every case. In multivariate analysis, the omission of drainage was not associated with increased need of postoperative CT scan or major complications but was a predictor of decreased length of stay.
The omission of postoperative drainage does not seem to increase the risk of postoperative complications and could safely be omitted after RPN.
我们旨在评估后腹腔镜肾部分切除术（RPN）后放置术后引流管的影响。
一项回顾性多中心研究纳入了2010年至2014年间在8个中心进行的RPN手术。3个中心在开展RPN手术初期就停止使用术后引流管，而其他机构则常规留置引流管。比较两组[引流组（D）和无引流组（ND）]的术前特征、并发症发生率、术后影像学检查或手术（外科或放射介入）需求以及住院时间。
在636例RPN手术中，140例未放置引流管（22%）。在ND组中，外科医生经验更丰富（>50例手术经验：55.7%对15.1%；p<0.0001），且肿瘤更复杂（RENAL评分：7.6对6.5；p<0.0001）。两组并发症发生率相似（21.9%对20.2%；p = 0.67）。未放置术后引流管并未增加CT扫描的需求（相对危险度RR = 1.03；95%可信区间CI 0.64 - 1.67）。ND组的住院时间更短（4.5天对5.5天；p = 0.007）。共有6例尿瘘：D组4例（0.8%），ND组2例（1.4%；p = 0.49）。每例均通过CT扫描确诊尿瘘。多因素分析显示，未放置引流管与术后CT扫描需求增加或主要并发症无关，但可预测住院时间缩短。
不放置术后引流管似乎不会增加术后并发症风险，后腹腔镜肾部分切除术后可安全省略该操作。
