经原腹腔引流管腔置入自制管芯持续冲洗负压引流治疗胰十二指肠切除术后胰瘘

目的 探讨和总结经原腹腔引流管置入自制管芯持续冲洗负压引流治疗胰十二指肠切除术（PD）术后胰瘘（POPF）的临床效果和经验。方法 回顾性分析衢州市人民医院2016年7月至2022年4月57例PD术后确诊为B级及以上POPF的病例临床资料。患者分别采用经原腹腔引流管置入自制管芯持续冲洗负压引流（观察组，n=30）及彩超定位下经皮腹腔穿刺置管引流（对照组，n=27）进行POPF的治疗，比较两组治疗效果。结果 两组POPF均成功治愈。观察组与对照组比较，术后发热时间[8(5,14)d vs 12(7,19)d,P=0.004]、继发腹腔感染率[23.33%(7/30) vs 59.26%(16/27),P=0.006]、切口感染率[16.67%(5/30) vs 40.74%(11/27),P=0.042]、胰瘘治愈时间[（14(7,19)d vs 18(12,31)d,P=0.047]、拔管时间[（22(15,35)d vs 35(23,56)d,P=0.001]、术后住院时间[21(18,29)d vs 33(25,47)d,P=0.009]均降低。所有病例均未发生意外拔管、继发腹腔大出...

Continuous irrigation and negative pressure drainage by inserting self-made tube core into the original peritoneal cavity drainage tube for treatment of pancreatic fistula after pancreaticoduodenectomy

Objective To investigate the clinical effect of continuous irrigation and negative pressure drainage by inserting self-made tube core into the original peritoneal cavity drainage tube for treatment of postoperative pancreatic fistula (POPF) after pancreaticoduodenectomy (PD). Methods Clinical data of 57 patients who diagnosed as POPF with grade B or above in Quzhou People’s Hospital between Jul. 2016 and Apr. 2022 were retrospectively analyzed. Patients were either treated with continuous irrigation and negative pressure drainage by inserting self-made tube core into the original peritoneal cavity drainage tubes (observation group, n=30) or percutaneous peritoneal puncture and drainage under color ultrasound location (control group, n=27). Treatment effects between the two groups were compared. Results All POPF cases were successfully cured in both groups. Compared with the control group, the observation group had lower time with postoperative fever [8(5, 14)d vs12(7, 19)d, P=0.004], lower secondary peritoneal infection rate [23.33%(7/30) vs 59.26%(16/27), P=0.006], lower incision infection rate [16.67%(5/30) vs 40.74%(11/27), P=0.042], lower time for pancreatic fistula healing [(14(7, 19)d vs 18(12, 31)d, P=0.047], lower time for bextubation [(22(15, 35)d vs 35(23, 56)d, P=0.001], and lower time for postoperative hospitalization [21(18, 29)d vs 33(25, 47)d, P=0.009]. No accidental extubation, secondary peritoneal hemorrhage, or gastrointestinal perforation occurred in the two groups. No case was found with re-operation or died. Conclusion Continuous irrigation and negative pressure drainage by inserting self-made tube core into the original peritoneal cavity drainage tube for treatment of postoperative pancreatic fistula is a safe and economical device and method improvement for treatment of POPF with less trauma and easay operation. The key to ensure successful treatment is to standardize operation and strengthen pipeline nursing management.