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Am J Surg. 2018 Nov;216(5):955-958. doi: 10.1016/j.amjsurg.2018.03.002. Epub 2018 Mar 10.
2
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6
Drain fluid and serum amylase concentration ratio is the most reliable indicator for predicting postoperative pancreatic fistula after distal pancreatectomy.引流液与血清淀粉酶浓度比值是预测远端胰腺切除术后胰瘘的最可靠指标。
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Impact of Drain Position on Drain Fluid Amylase, Fluid Collection and Postoperative Pancreatic Fistula after Distal Pancreatectomy.胰体尾切除术后引流管位置对引流液淀粉酶、液体收集及术后胰瘘的影响
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Low drain fluid amylase predicts absence of pancreatic fistula following pancreatectomy.低引流液淀粉酶可预测胰腺切除术后胰瘘的不存在。
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Evaluation of a predictive model for pancreatic fistula based on amylase value in drains after pancreatic resection.基于胰腺切除术后引流液淀粉酶值的胰瘘预测模型评估
Am J Surg. 2014 Oct;208(4):634-9. doi: 10.1016/j.amjsurg.2014.03.011. Epub 2014 Jun 12.

本文引用的文献

1
Evidence-Based Management of Drains Following Pancreatic Resection: A Systematic Review.胰十二指肠切除术后引流管的循证管理：一项系统评价
Pancreas. 2018 Jan;47(1):12-17. doi: 10.1097/MPA.0000000000000961.
2
Multicenter, Prospective Trial of Selective Drain Management for Pancreatoduodenectomy Using Risk Stratification.多中心前瞻性研究：基于风险分层的胰十二指肠切除术选择性引流管理。
Ann Surg. 2017 Jun;265(6):1209-1218. doi: 10.1097/SLA.0000000000001832.
3
Meta-analysis of drain amylase content on postoperative day 1 as a predictor of pancreatic fistula following pancreatic resection.术后第 1 天引流淀粉酶含量对胰腺切除术后胰瘘预测的荟萃分析。
Br J Surg. 2016 Mar;103(4):328-36. doi: 10.1002/bjs.10090. Epub 2016 Jan 21.
4
Early Drain Removal--The Middle Ground Between the Drain Versus No Drain Debate in Patients Undergoing Pancreaticoduodenectomy: A Prospective Validation Study.早期拔除引流管——胰十二指肠切除术患者引流与不引流之争的中间立场：一项前瞻性验证研究
Ann Surg. 2015 Aug;262(2):378-83. doi: 10.1097/SLA.0000000000001038.
5
Low drain fluid amylase predicts absence of pancreatic fistula following pancreatectomy.低引流液淀粉酶可预测胰腺切除术后胰瘘的不存在。
J Gastrointest Surg. 2014 Nov;18(11):1902-10. doi: 10.1007/s11605-014-2601-6. Epub 2014 Aug 12.
6
Evaluation of a predictive model for pancreatic fistula based on amylase value in drains after pancreatic resection.基于胰腺切除术后引流液淀粉酶值的胰瘘预测模型评估
Am J Surg. 2014 Oct;208(4):634-9. doi: 10.1016/j.amjsurg.2014.03.011. Epub 2014 Jun 12.
7
Intra-abdominal drainage after pancreatic resection: is it really necessary? A meta-analysis of short-term outcomes.胰腺切除术后的腹腔引流：真的有必要吗？一项短期结局的荟萃分析。
Int J Surg. 2014;12 Suppl 1:S40-7. doi: 10.1016/j.ijsu.2014.05.002. Epub 2014 May 10.
8
A randomized prospective multicenter trial of pancreaticoduodenectomy with and without routine intraperitoneal drainage.随机前瞻性多中心试验：胰十二指肠切除术联合与不联合常规腹腔引流的效果比较。
Ann Surg. 2014 Apr;259(4):605-12. doi: 10.1097/SLA.0000000000000460.
9
Is it time to abandon routine operative drain use? A single institution assessment of 709 consecutive pancreaticoduodenectomies.是否到了放弃常规手术引流的时候了？一家机构对 709 例胰十二指肠切除术的评估。
J Am Coll Surg. 2013 Apr;216(4):635-42; discussion 642-4. doi: 10.1016/j.jamcollsurg.2012.12.040.
10
Utility of drain fluid amylase measurement on the first postoperative day after pancreaticoduodenectomy.胰十二指肠切除术后第一天引流液淀粉酶测量的实用性。
World J Surg. 2012 Apr;36(4):879-83. doi: 10.1007/s00268-012-1460-0.

哪些预测因素有助于确定胰腺切除术后引流管安全拔除？

What are the predictors that can help identify safe removal of drains following pancreatectomy?

机构信息

Division of Surgical Oncology, Department of Surgery, Loyola University Medical Center, Maywood, Illinois, USA.

Division of Surgical Oncology, Department of Surgery, Loyola University Medical Center, Maywood, Illinois, USA.

出版信息

Am J Surg. 2018 Nov;216(5):955-958. doi: 10.1016/j.amjsurg.2018.03.002. Epub 2018 Mar 10.

DOI:10.1016/j.amjsurg.2018.03.002
PMID:29559084
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6131071/
Abstract

BACKGROUND

The management of a drain after Pancreaticoduodenectomy (PD) and distal pancreatectomy (DP) remains a controversial issue. Our aim in this study was to identify a safe time for drain removal.

STUDY DESIGN

This is a retrospective study, of a prospective database, of patients who underwent a PD or DP at two tertiary care institutions.

RESULTS

A total of 180 patients underwent PD and DP during the observation period. Seventeen patients developed fistulas (9.4%), with 70.6% (n = 12) developing in soft pancreatic remnants vs. 29.4% (n = 5) in firm pancreatic remnants. Patients with amylase levels greater than 173 U/L on a postoperative day three were 11.46 times more likely to form a fistula compared to those with an amylase level at or below 173 U/L (p < .001).

CONCLUSION

Fistula formation is associated with pancreas texture, duct size, and drain amylase following PD or DP. Patients with firm pancreatic texture and large ducts are less likely to develop fistulas than those with soft pancreatic texture and small ducts.

摘要

背景

胰十二指肠切除术（PD）和胰体尾切除术（DP）后引流管的管理仍是一个有争议的问题。我们的研究目的是确定安全的引流管拔除时间。

研究设计

这是一项回顾性研究，对在两个三级医疗机构接受 PD 或 DP 的患者的前瞻性数据库进行分析。

结果

在观察期间，共有 180 例患者接受了 PD 和 DP。17 例患者发生瘘（9.4%），其中 70.6%（n=12）发生在软胰腺残端，29.4%（n=5）发生在硬胰腺残端。术后第 3 天淀粉酶水平大于 173U/L 的患者发生瘘的可能性是淀粉酶水平在 173U/L 或以下的患者的 11.46 倍（p<0.001）。

结论

PD 或 DP 后瘘的形成与胰腺质地、胰管大小和引流管淀粉酶有关。与软胰腺质地和小胰管相比，质地坚硬且胰管较大的患者发生瘘的可能性较低。