Kuncewitch Michael P, Blackham Aaron U, Clark Clancy J, Dodson Rebecca M, Russell Gregory B, Levine Edward A, Shen Perry
Am Surg. 2019 Jan 1;85(1):1-7.
Surgical site infection (SSI) and incisional hernia are common complications after major pancreatectomy. We investigated the effects of negative pressure wound therapy (NPWT) on short- and long-term wound outcomes in patients undergoing pancreatectomy. A randomized controlled trial comparing the effect of NPWT with standard surgical dressing (SSD) on wounds was performed in 265 patients undergoing open gastrointestinal resections from 2012 to 2016. We performed a subset analysis of 73 patients who underwent pancreatectomy. Wound complications in the first 30 days and incisional hernia rates were assessed. There were 33 (45%) female patients in the study and the average BMI was 27.6. The pancreaticoduodectomy rate was 68 per cent, whereas 27 per cent of patients underwent distal or subtotal pancreatectomy, and 4 per cent total pancreatectomy. Incisional hernia rates were 32 per cent and 14 per cent between the SSD and NPWT groups, respectively ( = 0.067). In the SSD (n = 37) and NPWT (n = 36) cohorts, the superficial SSI, deep SSI, seroma, and dehiscence rates were 16 per cent and 14 per cent ( > 0.99), 5 per cent and 8 per cent ( = 0.67), 16 per cent and 11 per cent ( = 0.74), and 5 per cent and 3 per cent ( ≥ 0.99), respectively. After adjusting for pancreatic fistula and delayed gastric emptying, no statistically significant differences in the primary outcomes were observed. These findings were true irrespective of the type of resection performed. Short- and long-term wound complications were not improved with NPWT. We observed a trend toward decreased incisional hernia rates in patients treated with NPWT. Owing to the multifactorial nature of wound complications, it is yet to be determined which cohorts of pancreatectomy patients will benefit from NPWT.
手术部位感染（SSI）和切口疝是胰十二指肠切除术后常见的并发症。我们研究了负压伤口治疗（NPWT）对接受胰腺切除术患者短期和长期伤口结局的影响。2012年至2016年，对265例行开放性胃肠道切除术的患者进行了一项随机对照试验，比较NPWT与标准手术敷料（SSD）对伤口的影响。我们对73例接受胰腺切除术的患者进行了亚组分析。评估了前30天的伤口并发症和切口疝发生率。研究中有33名（45%）女性患者，平均体重指数为27.6。胰十二指肠切除术的比例为68%，而27%的患者接受了远端或次全胰腺切除术，4%的患者接受了全胰腺切除术。SSD组和NPWT组的切口疝发生率分别为32%和14%（P = 0.067）。在SSD组（n = 37）和NPWT组（n = 36）中，浅表SSI、深部SSI、血清肿和切口裂开发生率分别为16%和14%（P>0.99）、5%和8%（P = 0.67）、16%和11%（P = 0.74）以及5%和3%（P≥0.99）。在调整胰腺瘘和胃排空延迟因素后，主要结局未观察到统计学显著差异。无论进行何种类型的切除术，这些结果均成立。NPWT并未改善短期和长期伤口并发症。我们观察到接受NPWT治疗的患者切口疝发生率有下降趋势。由于伤口并发症具有多因素性质，尚需确定哪些胰腺切除术患者群体将从NPWT中获益。
