Xia Ning, Wang Li, Huang Xing, Wang Zihe, Xiong Junjie, Tian Bole
Division of Pancreatic Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, China.
Gland Surg. 2024 Nov 30;13(11):2043-2054. doi: 10.21037/gs-24-351. Epub 2024 Nov 26.
An increasing body of studies indicates that prophylactic abdominal drainage may not be necessary following left pancreatectomy (LP), despite its common use in clinical practice. This meta-analysis seeks to offer a definitive recommendation regarding the necessity of drainage after LP by examining and contrasting postoperative outcomes in patients who did and did not undergo drainage.
An extensive literature search was conducted to compare the outcomes of no-drainage and drainage after LP from inception to July 2024 on PubMed, MEDLINE, Embase, Web of Science, and the Cochrane Library. Fixed-effect models or random effects were selected based on heterogeneity, and pooled odds ratios (ORs) or mean differences (MDs) with 95% confidence intervals (CIs) were calculated.
A total of 10 studies with 3,505 patients were included, comprising two randomized controlled trials (RCTs) and eight observational clinical studies (OCS). There was no difference in major morbidity (Clavien-Dindo score ≥III) between the no-drainage and drainage groups (RCTs: OR =0.79; 95% CI: 0.54-1.15; P=0.22). However, the incidence of postoperative pancreatic fistula with grade B and C (POPF B/C) was lower (RCTs: OR =0.47; 95% CI: 0.30-0.73, P<0.001), and the length of hospital stay was shorter in the no-drainage group.. In RCTs, interventional drainage, reoperation, readmission, and mortality rates did not differ between the two groups.
No-drainage is completely safe and has a lower rate of POPF B/C compared to abdominal drainage after LP. Therefore, a no drainage policy should be implemented after LP.
越来越多的研究表明，尽管预防性腹腔引流在临床实践中常用，但在左半胰切除术（LP）后可能并非必要。本荟萃分析旨在通过检查和对比接受和未接受引流的患者的术后结果，就LP术后引流的必要性提供明确建议。
在PubMed、MEDLINE、Embase、Web of Science和Cochrane图书馆进行了广泛的文献检索，以比较从开始到2024年7月LP术后不引流和引流的结果。根据异质性选择固定效应模型或随机效应模型，并计算合并优势比（OR）或平均差（MD）以及95%置信区间（CI）。
共纳入10项研究，涉及3505例患者，包括两项随机对照试验（RCT）和八项观察性临床研究（OCS）。不引流组和引流组之间的主要发病率（Clavien-Dindo评分≥III）无差异（RCT：OR = 0.79；95% CI：0.54 - 1.15；P = 0.22）。然而，B级和C级术后胰瘘（POPF B/C）的发生率较低（RCT：OR = 0.47；95% CI：0.30 - 0.73，P < 0.001），且不引流组的住院时间较短。在RCT中，两组之间的介入性引流、再次手术、再次入院和死亡率无差异。
与LP术后腹腔引流相比，不引流是完全安全的，且POPF B/C发生率较低。因此，LP术后应实施不引流策略。
