Nagaoka Tomoyuki, Sakamoto Katsunori, Ogawa Kohei, Hikida Takahiro, Ito Chihiro, Iwata Miku, Sakamoto Akimasa, Shine Mikiya, Nishi Yusuke, Uraoka Mio, Honjo Masahiko, Tamura Kei, Takada Yasutsugu
Department of Hepato-Biliary-Pancreatic and Breast Surgery, Ehime University Graduate School of Medicine, Toon, Ehime, Japan.
Surg Laparosc Endosc Percutan Tech. 2024 Dec 1;34(6):571-577. doi: 10.1097/SLE.0000000000001318.
We investigated the relationship between the length of a prophylactic closed-suction drainage tube and clinically relevant postoperative pancreatic fistula (CR-POPF) in distal pancreatectomy (DP).
The clinical data of 76 patients who underwent DP using a reinforced stapler for the division of the pancreas at Ehime University Hospital between December 2017 and May 2023 were retrospectively analyzed. Laparoscopic DP was performed in 41 patients (53.9%). Closed-suction drainage was performed using a 19 Fr ExuFlow Round Drain with a vacuum bulb. The drainage tube length was defined as the distance between the peripancreatic stump site and the abdominal wall insertion site using abdominal radiography.
CR-POPF was observed in 12 patients (15.8%). Univariate analyses demonstrated that male sex ( P =0.020), American Society of Anesthesiologists Physical Status ( P =0.017), current smoking ( P =0.005), and drainage tube length ( P <0.001) were significantly associated with CR-POPF. The optimal cut-off value of drainage tube length for CR-POPF was 220 mm (area under the receiver operating characteristic curve=0.80). In multivariate analyses, drainage tube length (≥220 mm) was the sole independent predictor for CR-POPF (odds ratio, 6.59; P =0.023). According to computed tomography performed ∼1 week after surgery, the median volume of peripancreatic fluid collection was significantly higher in the long drainage tube group than in the short drainage tube group ( P <0.001).
A drainage tube inserted at a shorter distance to the pancreatic stump may reduce the incidence of CR-POPF after DP.
我们研究了预防性闭式吸引引流管的长度与远端胰腺切除术（DP）中临床相关的术后胰瘘（CR-POPF）之间的关系。
回顾性分析了2017年12月至2023年5月在爱媛大学医院接受使用强化吻合器进行胰腺分割的DP手术的76例患者的临床资料。41例患者（53.9%）接受了腹腔镜DP手术。使用带有真空球的19Fr ExuFlow圆形引流管进行闭式吸引引流。引流管长度定义为使用腹部X线摄影测量的胰周残端部位与腹壁插入部位之间的距离。
12例患者（15.8%）发生了CR-POPF。单因素分析表明，男性（P = 0.020）、美国麻醉医师协会身体状况分级（P = 0.017）、当前吸烟（P = 0.005）和引流管长度（P < 0.001）与CR-POPF显著相关。CR-POPF的引流管长度最佳截断值为220mm（受试者操作特征曲线下面积 = 0.80）。在多因素分析中，引流管长度（≥220mm）是CR-POPF的唯一独立预测因素（比值比，6.59；P = 0.023）。根据术后约1周进行的计算机断层扫描，长引流管组胰周积液的中位数体积显著高于短引流管组（P < 0.001）。
在距胰腺残端较短距离处插入引流管可能会降低DP术后CR-POPF的发生率。
