Heslin M J, Harrison L E, Brooks A D, Hochwald S N, Coit D G, Brennan M F
Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
J Gastrointest Surg. 1998 Jul-Aug;2(4):373-8. doi: 10.1016/s1091-255x(98)80077-2.
Closed suction drains after pancreaticoduodenectomy are theoretically used to drain potential collections and anastomotic leaks. It is unknown whether such drains are effective, harmful, or affect the outcome after this operation. Eighty-nine consecutive patients underwent pancreaticoduodenectomy for presumed periampullary malignancy and were retrospectively reviewed. Thirty-eight had no intra-abdominal drains and 51 had drains placed at the conclusion of the operation. We analyzed patient, nutritional, laboratory, and operating room factors with end points being complications and length of hospital stay. Intra-abdominal complications were defined as intra-abdominal abscess and pancreatic or biliary fistula. Postoperative interventions were defined as CT-guided drainage and reoperation. Analysis was by Student's t test and chi-square test. Two of eight surgeons contributed 92% of the patients without drains. The groups were equivalent with respect to demographic, nutritional, and operative factors. Time under anesthesia was significantly shorter in the group without drains (P = 0.0001). There was no statistical difference in the rate of fistula, abscess, CT drainage, or length of hospital stay. Intra-abdominal drainage did not significantly alter the risk of fistula, abscess, or reoperation or the necessity for CT-guided intervention after pancreaticoduodenectomy. Routine use of drains after pancreaticoduodenectomy may not be necessary and should be subjected to a randomized trial.
胰十二指肠切除术后使用闭式吸引引流管理论上是为了引出潜在的积液和吻合口漏液。目前尚不清楚此类引流管是否有效、有害或会影响该手术后的结局。对连续89例行胰十二指肠切除术以治疗疑似壶腹周围恶性肿瘤的患者进行回顾性分析。38例未放置腹腔引流管，51例在手术结束时放置了引流管。我们分析了患者、营养、实验室及手术室相关因素，终点指标为并发症和住院时间。腹腔内并发症定义为腹腔脓肿以及胰瘘或胆瘘。术后干预定义为CT引导下引流和再次手术。采用Student t检验和卡方检验进行分析。8名外科医生中有2名负责了92%未放置引流管的患者。两组在人口统计学、营养和手术因素方面相当。未放置引流管组的麻醉时间明显更短（P = 0.0001）。瘘、脓肿、CT引导下引流的发生率或住院时间方面无统计学差异。胰十二指肠切除术后腹腔内引流并未显著改变瘘、脓肿或再次手术的风险，也未改变CT引导下干预的必要性。胰十二指肠切除术后常规使用引流管可能没有必要，应进行随机试验。
