Wakasugi Masaki, Shimizu Junzo, Makutani Yusuke, Koga Chikato, Murakami Masahiro, Furukawa Haruna, Sueda Toshinori, Matsumura Tae, Miyagaki Hiromichi, Tei Mitsuyoshi, Kawabata Ryohei, Hasegawa Junichi
Department of Surgery, Osaka Rosai Hospital, Osaka, Japan.
Ann Med Surg (Lond). 2020 Apr 2;53:12-15. doi: 10.1016/j.amsu.2020.03.003. eCollection 2020 May.
Whether prophylactic abdominal drainage after laparoscopic liver resection (LLR) is necessary remains unclear. This study aimed to evaluate the safety of omitting prophylactic abdominal drainage after LLR.
A retrospective analysis of 100 consecutive patients who underwent LLR at Osaka Rosai Hospital from April 2011 to November 2018 was performed. During this period, prophylactic abdominal drainage was routinely omitted during LLR without biliary anastomosis. The primary endpoint was the frequency of additional abdominal drainage. The secondary endpoint was the rate of postoperative complications.
Ninety-six patients (96%) underwent partial resection or lateral segmentectomy, and 89 patients (89%) were Child-Pugh grade A. The median operative time was 102 (range, 31-274) minutes. The median blood loss was minimal (range, 0-280 ml), and blood transfusion was performed for one patient (1%). One case (1%) was converted to open surgery. Additional abdominal drainage was required for one patient (1%) with an intraabdominal abscess. Postoperative complications were seen in 5 patients (5%). High-grade complications (≥grade III according to the Clavien-Dindo classification) were seen in two patients (2%). There were no cases of reoperation or perioperative death. The median postoperative hospital stay was 8 (range, 4-65) days.
Prophylactic abdominal drainage could be safely omitted for selected patients and operative procedures.
腹腔镜肝切除术后（LLR）是否有必要进行预防性腹腔引流仍不明确。本研究旨在评估LLR术后不进行预防性腹腔引流的安全性。
对2011年4月至2018年11月在大阪罗赛医院连续接受LLR的100例患者进行回顾性分析。在此期间，在无胆肠吻合的LLR手术中常规不进行预防性腹腔引流。主要终点是额外腹腔引流的频率。次要终点是术后并发症发生率。
96例（96%）患者接受了部分切除术或外侧段切除术，89例（89%）患者为Child-Pugh A级。中位手术时间为102（范围31 - 274）分钟。中位失血量极少（范围0 - 280 ml），1例患者（1%）接受了输血。1例（1%）转为开腹手术。1例腹腔脓肿患者（1%）需要额外进行腹腔引流。5例患者（5%）出现术后并发症。2例患者（2%）出现高级别并发症（根据Clavien-Dindo分类≥III级）。无再次手术或围手术期死亡病例。术后中位住院时间为8（范围4 - 65）天。
对于部分患者和手术操作，可以安全地省略预防性腹腔引流。
