Hou Shengxiang, Hou Zonghao, Ren Li, Wang Zhixin, Wang Haijiu, Tie Chengwei, Deng Manjun, Fan Haining
Department of Hepatopancreatobiliary Surgery, Affiliated Hospital of Qinghai University, Qinghai, PR China.
Qinghai Research Key Laboratory for Echinococcosis, Qinghai, PR China.
Int J Surg. 2025 Jul 1;111(7):4772-4784. doi: 10.1097/JS9.0000000000002483. Epub 2025 May 20.
This meta-analysis aims to evaluate the effect of prophylactic abdominal drainage on post-pancreatectomy complications, a topic that is still debated in the medical community.
Following PRISMA guidelines, the authors conducted a systematic search across databases such as PubMed, EMBASE, Scopus, Cochrane Library, Ovid, clinicaltrials.gov, Web of Science, CNKI, and WanFang Data, focusing on studies comparing intraperitoneal drainage with no drainage after pancreatic surgery. Key outcomes included postoperative pancreatic fistula (POPF), clinically relevant POPF (CR-POPF), mortality, complications, delayed gastric emptying, bile leakage, intestinal fistula, abdominal abscess, postoperative bleeding, interventional radiology drainage, reoperation, and unplanned readmissions. Statistical analyses were conducted using either a Beta Normal Hierarchical Model or a random-effects model, providing combined odds ratios (ORs) with 95% confidence intervals (CIs). Subgroup analyses were also performed based on surgical procedures, specifically Distal Pancreatectomy (DP) and Pancreatoduodenectomy (PD).
This meta-analysis, incorporating five RCTs and 10 non-RCTs, identified a significant link between routine abdominal drainage and higher rates of POPF, CR-POPF, and unplanned readmissions. The overall ORs were 2.46 (95% CI: 1.90-3.63), 1.92 (95% CI: 1.38-2.64), and 1.32 (95% CI: 1.04-1.65). In the DP subgroup, the ORs were 2.48 (95% CI: 1.49-5.00), 2.75 (95% CI: 1.65-5.21), and 1.46 (95% CI: 1.06-2.18). In the PD subgroup, the ORs were 2.34 (95% CI: 1.70-3.36), 1.95 (95% CI: 1.17-3.19), and 1.25 (95% CI: 1.00-1.60). The use of drainage was associated with a decreased mortality following PD, with an OR of 0.49 (95% CI: 0.23-0.96); however, this association was not observed in relation to other surgical methods. No significant differences were found among the groups for the other outcomes.
For surgeries other than PD, omitting drainage tubes may benefit patients postoperatively. However, unselected cessation of intraperitoneal drainage after PD correlates with reduced pancreatic fistulas but higher mortality. Future randomized trials should compare routine versus selective drainage.
本荟萃分析旨在评估预防性腹部引流对胰腺切除术后并发症的影响，这一话题在医学界仍存在争议。
作者遵循PRISMA指南，对PubMed、EMBASE、Scopus、Cochrane图书馆、Ovid、clinicaltrials.gov、科学引文索引、中国知网和万方数据等数据库进行了系统检索，重点关注比较胰腺手术后腹腔引流与不引流的研究。主要结局包括术后胰瘘（POPF）、临床相关胰瘘（CR-POPF）、死亡率、并发症、胃排空延迟、胆漏、肠瘘、腹腔脓肿、术后出血、介入放射学引流、再次手术和计划外再入院。使用贝塔正态分层模型或随机效应模型进行统计分析，提供合并比值比（OR）及95%置信区间（CI）。还根据手术方式进行了亚组分析，具体为胰体尾切除术（DP）和胰十二指肠切除术（PD）。
本荟萃分析纳入了5项随机对照试验和10项非随机对照试验，发现常规腹部引流与较高的POPF、CR-POPF和计划外再入院率之间存在显著关联。总体OR分别为2.46（95%CI：1.90 - 3.63）、1.92（95%CI：1.38 - 2.64）和1.32（95%CI：1.04 - 1.65）。在DP亚组中，OR分别为2.48（95%CI：1.49 - 5.00）、2.75（95%CI：1.65 - 5.21）和1.46（95%CI：1.06 - 2.18）。在PD亚组中，OR分别为2.34（95%CI：1.70 - 3.36）、1.95（95%CI：1.17 - 3.19）和1.25（95%CI：1.00 - 1.60）。PD术后使用引流与死亡率降低相关，OR为0.49（95%CI：0.23 - 0.96）；然而，在其他手术方法中未观察到这种关联。在其他结局方面，各组之间未发现显著差异。
对于除PD以外的手术，不放置引流管可能对患者术后有益。然而，PD后未经选择地停止腹腔引流与胰瘘减少但死亡率升高相关。未来的随机试验应比较常规引流与选择性引流。
