结直肠急症手术后放置腹腔引流管的安全性和疗效：一项国际性前瞻性队列研究。
Safety and efficacy of intraperitoneal drain placement after emergency colorectal surgery: An international, prospective cohort study.
出版信息
Colorectal Dis. 2023 Oct;25(10):2043-2053. doi: 10.1111/codi.16737. Epub 2023 Sep 12.
AIM
Intraperitoneal drains are often placed during emergency colorectal surgery. However, there is a lack of evidence supporting their use. This study aimed to describe the efficacy and safety of intraperitoneal drain placement after emergency colorectal surgery.
METHOD
COMPlicAted intra-abdominal collectionS after colorectal Surgery (COMPASS) is a prospective, international, cohort study into which consecutive adult patients undergoing emergency colorectal surgery were enrolled (from 3 February 2020 to 8 March 2020). The primary outcome was the rate of intraperitoneal drain placement. Secondary outcomes included rate and time-to-diagnosis of postoperative intraperitoneal collections, rate of surgical site infections (SSIs), time to discharge and 30-day major postoperative complications (Clavien-Dindo III-V). Multivariable logistic and Cox proportional hazards regressions were used to estimate the independent association of the outcomes with drain placement.
RESULTS
Some 725 patients (median age 68.0 years; 349 [48.1%] women) from 22 countries were included. The drain insertion rate was 53.7% (389 patients). Following multivariable adjustment, drains were not significantly associated with reduced rates (odds ratio [OR] = 1.56, 95% CI: 0.48-5.02, p = 0.457) or earlier detection (hazard ratio [HR] = 1.07, 95% CI: 0.61-1.90, p = 0.805) of collections. Drains were not significantly associated with worse major postoperative complications (OR = 1.26, 95% CI: 0.67-2.36, p = 0.478), delayed hospital discharge (HR = 1.11, 95% CI: 0.91-1.36, p = 0.303) or increased risk of SSIs (OR = 1.61, 95% CI: 0.87-2.99, p = 0.128).
CONCLUSION
This is the first study investigating placement of intraperitoneal drains following emergency colorectal surgery. The safety and clinical benefit of drains remain uncertain. Equipoise exists for randomized trials to define the safety and efficacy of drains in emergency colorectal surgery.
目的
在紧急结直肠手术中常放置腹腔引流管。然而，目前缺乏支持其使用的证据。本研究旨在描述紧急结直肠手术后放置腹腔引流管的疗效和安全性。
方法
COMPlicAted intra-abdominal collectionS after colorectal Surgery (COMPASS) 是一项前瞻性、国际性队列研究，连续纳入接受紧急结直肠手术的成年患者（2020 年 2 月 3 日至 2020 年 3 月 8 日）。主要结局是腹腔引流管放置率。次要结局包括术后腹腔内积液的发生率和诊断时间、手术部位感染（SSI）发生率、出院时间和 30 天主要术后并发症（Clavien-Dindo III-V 级）。多变量逻辑和 Cox 比例风险回归用于估计结局与引流管放置的独立关联。
结果
共纳入来自 22 个国家的 725 例患者（中位年龄 68.0 岁；349 例[48.1%]为女性）。引流管插入率为 53.7%（389 例）。多变量调整后，引流管与降低发生率（比值比 [OR] = 1.56，95%CI：0.48-5.02，p = 0.457）或更早检测（风险比 [HR] = 1.07，95%CI：0.61-1.90，p = 0.805）无显著相关性。引流管与更严重的术后主要并发症（OR = 1.26，95%CI：0.67-2.36，p = 0.478）、延迟出院（HR = 1.11，95%CI：0.91-1.36，p = 0.303）或 SSI 风险增加（OR = 1.61，95%CI：0.87-2.99，p = 0.128）无关。
结论
这是第一项研究紧急结直肠手术后放置腹腔引流管的研究。引流管的安全性和临床获益仍不确定。需要进行随机试验来确定紧急结直肠手术中引流管的安全性和疗效。
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