Pollini Tommaso, Wong Paul, Kone Lyonell B, Khoury Rym El, Kabir Chris, Maker Vijay K, Banulescu Mihaela, Maker Ajay V
Division of Surgical Oncology, Department of Surgery, University of California San Francisco, San Francisco, USA.
Department of Surgery, University of Illinois at Chicago, Creticos Cancer Center at Advocate Illinois Masonic Medical Center, Chicago, IL, USA.
J Gastrointest Surg. 2023 Apr;27(4):724-729. doi: 10.1007/s11605-023-05612-0. Epub 2023 Feb 3.
Despite multiple studies and randomized trials, there remains controversy over whether drains should be placed, and if so for how long, after pancreas resection. The aim was to determine if post-pancreatectomy drain placement and timing of drain removal were associated with differences in infectious outcomes and, if so, which specific procedures and infectious sites were most at risk.
The ACS-NSQIP targeted pancreatectomy database was utilized to identify patients who underwent pancreatectomies between 2015 and 2020 with postoperative drain placement for retrospective cohort analysis. A propensity score matching analyses was conducted to determine associations between drain placement and surgical site infections (SSI).
Of 39,057 pancreatic resections, 66.4% were proximal pancreatectomies, and 33.6% were distal pancreatectomies. After propensity score matching, drain placement was not associated with significantly lower rates of superficial SSI (7% vs 9%, p = 0.755) or organ/space SSI (17% vs 16%, p = 0.647) after proximal pancreatectomy. After distal pancreatectomy, drain placement was associated with higher rates of organ/space SSI (12% vs 9%, p = 0.010). Drain removal on or after postoperative day 3 was significantly associated with higher rates of SSI in both proximal and distal pancreatectomy.
Drain placement is associated with an increased rate of organ/space SSI after distal pancreatectomy and not after pancreaticoduodenectomy. When drains are utilized, early removal is associated with a reduction of SSI after all types of pancreatectomy. In surgical units where post-pancreatectomy SSI is a concern, selective drain placement for high-risk glands or after distal pancreatectomy, combined with early drain removal, may be considered.
尽管进行了多项研究和随机试验，但对于胰腺切除术后是否应放置引流管以及如果放置应放置多长时间仍存在争议。目的是确定胰腺切除术后引流管的放置和拔除时间是否与感染结局的差异相关，如果是，哪些特定手术和感染部位风险最高。
利用美国外科医师学会国家外科质量改进计划（ACS-NSQIP）的靶向胰腺切除术数据库，识别2015年至2020年间接受胰腺切除术并术后放置引流管的患者，进行回顾性队列分析。进行倾向评分匹配分析以确定引流管放置与手术部位感染（SSI）之间的关联。
在39057例胰腺切除术中，66.4%为胰头切除术，33.6%为胰体尾切除术。倾向评分匹配后，胰头切除术后引流管放置与浅表SSI发生率显著降低无关（7%对9%，p = 0.755）或器官/腔隙SSI发生率显著降低无关（17%对16%，p = 0.647）。胰体尾切除术后，引流管放置与器官/腔隙SSI发生率较高相关（12%对9%，p = 0.010）。术后第3天或之后拔除引流管与胰头和胰体尾切除术的SSI发生率较高显著相关。
胰体尾切除术后引流管放置与器官/腔隙SSI发生率增加相关，而胰十二指肠切除术后则不然。当使用引流管时，早期拔除与所有类型胰腺切除术后SSI的减少相关。在关注胰腺切除术后SSI的手术科室，可考虑对高危腺体或胰体尾切除术后进行选择性引流管放置，并结合早期引流管拔除。
