Department of Surgery, Shiga University of Medical Science, Setatsukinowa-cho, Otsu, Shiga, 520-2192, Japan.
Langenbecks Arch Surg. 2023 Nov 3;408(1):427. doi: 10.1007/s00423-023-03165-z.
This study aimed to investigate the risk factors for re-drainage in patients with early drain removal after pancreaticoduodenectomy (PD).
This study retrospectively analyzed 114 patients who underwent PD and prophylactic drain removal on postoperative day (POD) 4 between January 2012 and March 2021. We analyzed the risk factors for re-drainage according to various factors. Peri-pancreaticojejunostomic fluid collection (PFC) index and pancreatic cross-sectional area (CSA) were evaluated using computed tomography on POD 4. The PFC index was calculated by multiplying the length, width, and height at the maximum aspect.
Among the 114 patients, 15 (13%) underwent re-drainage due to postoperative pancreatic fistula. Multivariate analysis identified a PFC index ≥ 8.16 cm on POD 4 (odds ratio [OR], 20.40, 95%CI 2.38-174.00; p = 0.006) and pancreatic CSA on POD 4 ≥ 3.65 cm (OR, 16.40, 95%CI 1.57-171.00; p = 0.020) as independent risk factors for re-drainage.
A careful decision might be necessary for early drain removal in patients with a PFC index ≥ 8.16 cm and pancreatic CSA ≥ 3.65 cm.
本研究旨在探讨胰十二指肠切除术后（PD）早期拔除引流管后再引流的危险因素。
本研究回顾性分析了 2012 年 1 月至 2021 年 3 月间 114 例行 PD 并于术后第 4 天行预防性引流管拔除的患者。我们根据各种因素分析了再引流的危险因素。术后第 4 天行 CT 评估胰肠吻合口周围积液（PFC）指数和胰腺横截面积（CSA）。PFC 指数通过最大层面的长度、宽度和高度相乘计算得出。
在 114 例患者中，有 15 例（13%）因术后胰瘘而再次引流。多因素分析显示术后第 4 天 PFC 指数≥8.16cm（优势比[OR]，20.40，95%可信区间[CI] 2.38-174.00；p=0.006）和胰腺 CSA 术后第 4 天≥3.65cm（OR，16.40，95%CI 1.57-171.00；p=0.020）是再引流的独立危险因素。
对于 PFC 指数≥8.16cm 和胰腺 CSA≥3.65cm 的患者，可能需要谨慎决定是否早期拔除引流管。
