Department of Biomedical Sciences, Humanitas University, Via Montalcini 4, 20090, Pieve Emanuele , Milan, Italy.
Department of Hepatobiliary and General Surgery, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy.
Updates Surg. 2022 Aug;74(4):1317-1326. doi: 10.1007/s13304-022-01301-w. Epub 2022 Jun 3.
Despite current evidence, the use of drains in liver surgery is still controversial. We conducted an international survey to investigate the clinical use of drains in the E-AHPBA, A-HPBA and A-PHPBA communities. An open survey of 30 questions was prepared on Google-Form and distributed by email to all members. One hundred and ninety-one HPB surgeons responded to the survey. One hundred and twelve surgeons (58.6%) reported routine use of abdominal drains after liver resections. Eighty-eight (46.1%) responded that removal was driven by low volume and low bilirubin levels in the drains. For minor liver resection, 97 (50.8%) surgeons reported using drains selectively; in contrast, 134 (70.2%) surgeons prefer to use a drain always after major procedures. Among patients with cirrhosis, 87 (45.5%) surgeons reported routine drains placement, while 84 (44.0%) considered drains selectively. A no-drain policy was most prevalent among surgeons from North America (80%) versus Asian-Pacific (70.0%), European and African (60.8%), and South American (61.5%) surgeons. Among minimally invasive surgeons, 74.2% reported drain use only in selected cases versus 35.0% among surgeons who performed open surgery. The practice of draining after liver surgery is still highly variable among centers and surgeons around the world, with a high variability according to the underlying liver condition and planned surgical approach.
尽管目前已有证据，但在肝外科手术中使用引流管仍然存在争议。我们进行了一项国际调查，以调查 E-AHPBA、A-HPBA 和 A-PHPBA 社区中引流管的临床使用情况。我们在 Google 表单上准备了一份包含 30 个问题的开放式调查，并通过电子邮件分发给所有成员。191 名肝胆胰外科医生对该调查做出了回应。112 名外科医生（58.6%）报告在肝切除术后常规使用腹部引流管。88 名外科医生（46.1%）表示，引流管的移除取决于引流管中的低容量和低胆红素水平。对于较小的肝切除术，97 名外科医生（50.8%）报告选择性使用引流管；相比之下，134 名外科医生（70.2%）更喜欢在主要手术后始终使用引流管。在肝硬化患者中，87 名外科医生（45.5%）报告常规放置引流管，而 84 名外科医生（44.0%）认为引流管是选择性放置的。北美（80%）外科医生比亚太地区（70.0%）、欧洲和非洲（60.8%）以及南美（61.5%）外科医生更倾向于采用无引流管政策。在微创外科医生中，74.2%的人报告仅在选择性病例中使用引流管，而 35.0%的开放手术外科医生则使用引流管。在全球范围内，肝手术后引流的做法在各个中心和外科医生之间仍然高度可变，并且根据潜在的肝脏状况和计划的手术方法存在很大的差异。
