早期拔除腹腔引流管减少胰十二指肠切除术后胰瘘的回顾性研究

目的 探讨胰十二指肠切除手术(pancreaticoduodenectomy,PD)后早期拔除腹腔引流管能否减少术后胰瘘发生.方法 回顾性分析西南医院肝胆外科2013年1月至2015年10月收治并依据纳入排除标准归入研究对象的305例PD手术患者的临床资料,按术后腹腔引流管拔除时间分为:A组,术后≤5 d拔除;B组,术后＞5d拔除.比较两组患者术后并发症等发生情况,对胰瘘发生的相关因素进行单因素和多因素分析.结果 术后胰瘘(3.1％vs12.1％)、腹腔感染(9.2％ vs 20.3％)以及总并发症(24.5％ vs 42.0％)发生率A组均显著低于B组(P＜0.05),术后住院时间也明显缩短13.0(4 ～44)d vs 15.5(9 ～64)d,P＜0.05].单因素分析示:性别(P＜0.05)、术前有无显性黄疸(P＜0.05)、胰管直径(＜3 mm vs ≥3 mm,P＜0.05)、肿瘤发生部位(胰腺vd胰腺外,P＜0.01)、腹腔引流管拔除时间(≤5dvs ＞5d,P＜0.05)为术后胰瘘发生的影响因素;多因素Logistic回归分析示:男性、胰管直径＜3 mm、胰腺外肿瘤(胆总管远端、十二指肠乳头部、胆胰壶腹部肿瘤)、腹腔引流管拔除时间＞5d为胰瘘发生的独立危险因素(OR=4.424,2.369,3.874,5.028,P＜0.05).结论 对于PD术后早期无胰瘘发生的患者,术后5d内拔除腹腔引流管能够显著减少术后胰瘘、腹腔感染等并发症,延长腹腔引流管留置时间会增加术后胰瘘发生率.

Early removal of intra-abdominal drainage reduces the incidence of pancreatic fistula after pancreaticoduodenectomy

Objective To investigate whether early removal of intra-abdominal drainage reduces the incidence of pancreatic fistula after pancreaticoduodenectomy (PD).Methods A total of 305 patients undergoing PD in Southwest Hospital between January 2013 and October 2015 were retrospectively analyzed.Intra-abdominal drainage was removed within 5 d following PD in 98 cases (group A) and after 5 days in 207 cases (group B).The postoperative complications were compared between the 2 groups,and the risk factors associated with pancreatic fistula were evaluated using univariate and multivariate analyses.Results Compared with those in group B,the patients in group A showed significantly lowered incidences of pancreatic fistula (3.1％ vs 12.1％),abdominal infections (9.2％ vs 20.3％),and overall complications (24.5％ vs42.0％) after PD (P ＜ 0.05) with also shortened postoperative hospital stay 13.0 (4 ～ 44) vs 15.5 (9 ～64) d,P ＜0.05].Univariate analysis identified gender (P =0.031),preoperative clinical jaundice (P =0.035),pancreatic duct diameter (＜ 3 mm vs ≥3 mm,P ＜ 0.05),tumor location (in the pancreas or not,P=0.011) and the removal time of intra-abdominal drainage (within or after 5 d following PD,P =0.011)as the risk factors of pancreatic fistula;logistic regression analysis revealed that a male gender (OR =4.424),a pancreatic duct diameter ＜ 3 mm (OR =2.369),tumors in the distal bile duct,duodenum or ampulla (OR =3.874),and dwelling time of intra-abdominal drainage for over 5 d following PD (OR =5.028) as the independent risk factors of pancreatic fistula following PD (P ＜ 0.05).Conclusion In patients free of pancreatic fistula early after PD,removing intra-abdominal drainage within 5 d can reduce the incidences of postoperative pancreatic fistula and abdominal infections,and a delayed removal of the drainage is strongly associated with an increased risk of pancreatic fistula.