Lee Seung Jae, Choi In Seok, Moon Ju Ik, Yoon Dae Sung, Choi Won Jun, Lee Sang Eok, Sung Nak Song, Kwon Seong Uk, Bae In Eui, Roh Seung Jae, Kim Sung Gon
Department of Surgery, Konyang University Hospital, Konyang University College of Medicine, Daejeon, Korea.
J Minim Invasive Surg. 2022 Jun 15;25(2):63-72. doi: 10.7602/jmis.2022.25.2.63.
This study was performed to investigate the effect of drain placement on complicated laparoscopic cholecystectomy (cLC) for acute cholecystitis (AC).
This single-center retrospective study reviewed patients with AC who underwent cLC between January 2010 and December 2020. cLC was defined as open conversion, subtotal cholecystectomy, adjacent organ injury during surgery, operation time of ≥90 minutes, or estimated blood loss of ≥100 mL. One-to-one propensity score matching was performed to compare the surgical outcomes between patients with and without drain on cLC.
A total of 216 patients (mean age, 65.8 years; 75 female patients [34.7%]) underwent cLC, and 126 (58.3%) underwent intraoperative abdominal drainage. In the propensity score-matched cohort (61 patients in each group), early drain removal (≤postoperative day 3) was performed in 42 patients (68.9%). The overall rate of surgical site infection (SSI) was 10.7%. Late drain removal demonstrated significantly worse surgical outcomes than no drain placement and early drain removal for overall complications (13.1% vs. 21.4% vs. 47.4%, = 0.006), postoperative hospital stay (3.8 days vs. 4.4 days vs. 12.7 days, < 0.001), and SSI (4.9% vs. 11.9% vs. 31.6%, = 0.006). In the multivariate analysis, late drain removal was the most significant risk factor for organ space SSI.
This study demonstrated that drain placement is not routinely recommended, even after cLC for AC. When placing a drain, early drain removal is recommended because late drain removal is associated with a higher risk of organ space SSI.
本研究旨在探讨引流管放置对急性胆囊炎（AC）复杂腹腔镜胆囊切除术（cLC）的影响。
本单中心回顾性研究纳入了2010年1月至2020年12月期间接受cLC的AC患者。cLC定义为中转开腹、胆囊次全切除术、术中邻近器官损伤、手术时间≥90分钟或估计失血量≥100 mL。采用一对一倾向评分匹配法比较cLC中有引流管和无引流管患者的手术结局。
共有216例患者（平均年龄65.8岁；75例女性患者[34.7%]）接受了cLC，其中126例（58.3%）接受了术中腹腔引流。在倾向评分匹配队列（每组61例患者）中，42例患者（68.9%）进行了早期拔管（≤术后第3天）。手术部位感染（SSI）的总体发生率为10.7%。对于总体并发症（13.1% vs. 21.4% vs. 47.4%，P = 0.006）、术后住院时间（3.8天 vs. 4.4天 vs. 12.7天，P < 0.001）和SSI（4.9% vs. 11.9% vs. 31.6%，P = 0.006），延迟拔管的手术结局明显比未放置引流管和早期拔管更差。在多因素分析中，延迟拔管是器官间隙SSI的最显著危险因素。
本研究表明，即使在AC的cLC术后，也不常规推荐放置引流管。如需放置引流管，建议早期拔管，因为延迟拔管与器官间隙SSI的风险较高相关。
