吸力的力量：封闭式吸引与重力引流在术后胰瘘中的理论与实践。

The power of suction: Theory and practice in closed suction vs gravity drains and postoperative pancreatic fistulas.

机构信息

OHSU School of Medicine, Portland, OR, 97239, USA.

Oregon Health & Science University (OHSU), Department of Surgery, Portland, OR, 97239, USA.

出版信息

Am J Surg. 2022 Aug;224(2):737-741. doi: 10.1016/j.amjsurg.2022.02.063. Epub 2022 Mar 1.

DOI:10.1016/j.amjsurg.2022.02.063

PMID:35248372

Abstract

BACKGROUND

Postoperative pancreatic fistula (POPF) is a feared complication in pancreatic resection. Gravity drainage (GD) is hypothesized to reduce POPF versus closed-suction drainage (CSD). We sought to evaluate this theory.

METHODS

Six-hundred-twenty-nine patients undergoing pancreatic resection between 2013 and 2020 were analyzed with multivariable logistic regression for the outcomes of POPF and clinically-relevant POPF (crPOPF).

RESULTS

Three-hundred-ninety-seven patients (63.1%) underwent pancreaticoduodenectomy and 232 (36.9%) underwent distal pancreatectomy. Suction drains were placed in 588 patients (93.5%) whereas 41 (6.5%) had GDs. One-hundred-twenty-five (27.6%) experienced a POPF; 49 (10%) crPOPFs. On multivariable analysis, suction drainage was not associated with increased risk of POPF (OR 0.76, 95% CI 0.30-1.93, P = 0.57) or crPOPF (OR 0.99, 95% CI 0.30-3.26, P = 0.98).

CONCLUSION

Suction drainage does not promote POPF when compared to GDs. Drain type should be determined by surgeon preference, while taking into account nursing and patient-specific considerations especially when patients are discharged with drains.

摘要

背景

术后胰瘘（POPF）是胰腺切除术后的一种严重并发症。重力引流（GD）被认为可以降低 POPF 的发生率，优于封闭式负压引流（CSD）。我们旨在验证这一理论。

方法

对 2013 年至 2020 年间接受胰腺切除术的 629 例患者进行多变量逻辑回归分析，以评估 POPF 和临床相关 POPF（crPOPF）的结局。

结果

397 例（63.1%）患者行胰十二指肠切除术，232 例（36.9%）患者行胰体尾切除术。588 例（93.5%）患者放置了引流管，41 例（6.5%）患者采用了 GD。125 例（27.6%）患者发生 POPF，49 例（10%）发生 crPOPF。多变量分析显示，引流方式与 POPF 的发生风险（OR 0.76，95%CI 0.30-1.93，P=0.57）或 crPOPF 的发生风险（OR 0.99，95%CI 0.30-3.26，P=0.98）无关。