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

黄涛; 杨美文; 张雷达

doi:10.16016/j.1000-5404.201612207

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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

临床医学 | 更新时间：2026-02-09

- 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
- Early removal of intra-abdominal drainage reduces the incidence of pancreatic fistula after pancreaticoduodenectomy
- 第三军医大学学报 2017年39卷第10期页码：1019-1024
- 作者机构：
  
  400038 重庆，第三军医大学西南医院全军肝胆外科研究所
- 作者简介：
  
  [张雷达，E-mail:2518569931@qq.comZhang Leida, E-mail:2518569931@qq.com
- 基金信息：
- DOI：10.16016/j.1000-5404.201612207
  中图分类号： R619;R657.5
- 收稿：2016-12-29，
  
  修回：2017-01-08，
  
  纸质出版：2017-05-30
- 稿件说明：
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黄涛, 杨美文, 张雷达. 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[J]. 第三军医大学学报, 2017,39(10):1019-1024.

Tao Huang, Meiwen Yang, Leida Zhang. Early removal of intra-abdominal drainage reduces the incidence of pancreatic fistula after pancreaticoduodenectomy[J]. Journal of Third Military Medical University, 2017, 39(10): 1019-1024.
黄涛, 杨美文, 张雷达. 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[J]. 第三军医大学学报, 2017,39(10):1019-1024. DOI： 10.16016/j.1000-5404.201612207.

Tao Huang, Meiwen Yang, Leida Zhang. Early removal of intra-abdominal drainage reduces the incidence of pancreatic fistula after pancreaticoduodenectomy[J]. Journal of Third Military Medical University, 2017, 39(10): 1019-1024. DOI： 10.16016/j.1000-5404.201612207.

摘要

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＞5 d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%

12.1%)、腹腔感染(9.2%

20.3%)以及总并发症(24.5%

42.0%)发生率A组均显著低于B组(

0.05)，术后住院时间也明显缩短。单因素分析示：性别(

0.05)、术前有无显性黄疸(

0.05)、胰管直径(

3 mm

≥3 mm，

0.05)、肿瘤发生部位(胰腺

胰腺外，

0.01)、腹腔引流管拔除时间(≤5 d

5 d，

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

5 d为胰瘘发生的独立危险因素(

=4.424

2.369

3.874

5.028

0.05)。

结论

对于PD术后早期无胰瘘发生的患者，术后5 d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。

Abstract

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 inc

idences of pancreatic fistula (3.1%

12.1%)

abdominal infections (9.2%

20.3%)

and overall complications (24.5%

42.0%) after PD (

0.05) with also shortened postoperative hospital stay. Univariate analysis identified gender (

=0.031)

preoperative clinical jaundice (

=0.035)

pancreatic duct diameter (

3 mm

≥3 mm

0.05)

tumor location (in the pancreas or not

=0.011) and the removal time of intra-abdominal drainage (within or after 5 d following PD

=0.011) as the risk factors of pancreatic fistula; logistic regression analysis revealed that a male gender (

=4.424)

a pancreatic duct diameter

3 mm (

=2.369)

tumors in the distal bile duct

duodenum or ampulla (

=3.874)

and dwelling time of intra-abdominal drainage for over 5 d following PD (

=5.028) as the independent risk factors of pancreatic fistula following PD (

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.

关键词

Keywords

references

El Nakeeb A, Salah T, Sultan A, et al. Pancreatic anastomotic leakage after pancreaticoduodenectomy. Risk factors, clinical predictors, and management (single center experience)[J]. World J Surg, 2013, 37(6): 1405-1418. DOI: 10.1007/s00268-013-1998-5.

Jin S, Shi X J, Sun X D, et al. The Gastric/Pancreatic Amylase Ratio Predicts Postoperative Pancreatic Fistula With High Sensitivity and Specificity[J]. Medicine, 2015, 94(3): e339. DOI:10.1097/md.dsjydxxb-39-10-101900339.

Chen J Y, Feng J, Wang X Q, et al. Risk scoring system and predictor for clinically relevant pancreatic fistula after pancreaticoduodenectomy[J]. World J Gastroenterol, 2015, 21(19): 5926-5933. DOI:10.3748/wjg.v21.i19.5926.

Kawai M, Tani M, Terasawa H, et al. Early removal of prophylactic drains reduces the risk of intra-abdominal infections in patients with pancreatic head resection: prospective study for 104 consecutive patients[J]. Ann Surg, 2006, 244(1): 1-7. DOI: 10.1097/01.sla.0000218077.14035.a6.

Bassi C, Molinari E, Malleo G, et al. Early versus late drain removal after standard pancreatic resections: results of a prospective randomized trial[J]. Ann Surg, 2010, 252(2): 207-214. DOI: 10.1097/SLA.0b013e3181e61e88.

Bassi C, Dervenis C, Butturini G, et al. Postoperative pancreatic fistula: an international study group (ISGPF) definition[J]. Surgery, 2005, 138(1): 8-13. DOI: 10.1016/j.surg.2005.05.001.

朱宏达, 马尘超, 白岳青, 等.胰十二指肠切除术后腹腔并发症发生及引流留置时间预测[J].肝胆胰外科杂志, 2014, 26(5): 372-375.

Zhu H D, Ma C C, Bai Y Q, et al. Prediction for abdominal complications and drainage indwelling duration after pancreatic-oduodenectomy[J]. Journal of Hepatopancreatobiliary Surgery, 2014, 26(5): 372-375.

Meng G, Xing Q, Yuan Q, et al. Internal compared with external drainage of pancreatic duct during pancreaticoduodenectomy: a retrospective study[J]. Chin J Cancer Res, 2014, 26(3): 277-284. DOI: 10.3978/j.issn.1000-9604.2014.06.05.

Lee C W, Pitt H A, Riall T S, et al. Low drain fluid amylase predicts absence of pancreatic fistula following pancreatectomy[J]. J Gastrointest Surg, 2014, 18(11): 1902-1910. DOI: 10.1007/s11605-014-2601-6.

Yang J, Huang Q, Wang C. Postoperative drain amylase predicts pancreatic fistula in pancreatic surgery: A systematic review and meta-analysis[J]. International Journal of Surgery, 2015, 22: 38-45. DOI: 10.1016/j.ijsu.2015.07.007.

Wang Y C, Szatmary P, Zhu J Q, et al. Prophylactic intra-peritoneal drain placement following pancreaticoduodenectomy: a systematic review and meta-analysis[J]. World J Gastroenterol, 2015, 21(8): 2510-2521.DOI: 10.3748/wjg.v21.i8.2510.

Reid-Lombardo K M, Farnell M B, Crippa S, et al. Pancreatic anastomotic leakage after pancreaticoduodenectomy in 1, 507 patients: a report from the Pancreatic Anastomotic Leak Study Group[J]. J Gastrointest Surg, 2007, 11(11): 1451-1458. DOI: 10.1007/s11605-007-0270-4.

Gurusamy K, Samraj K, Mullerat P, et al. Routine abdominal drainage for uncomplicated laparoscopic cholecystectomy[J]. Cochrane Database of Systematic Reviews, 2007. DOI: 10.1002/14651858.cd006004.pub2.

Karliczek A, Jesus E C, Matos D, et al. Drainage or nondrainage in elective colorectal anastomosis: a systematic review and meta-analysis[J]. Colorectal Dis, 2006, 8(4): 259-265. DOI: 10.1111/j.1463-1318.2006.00999.x.

Aldameh A, McCall J L, Koea J B. Is routine placement of surgical drains necessary after elective hepatectomy? Results from a single institution[J]. J Gastrointest Surg, 2005, 9(5): 667-671. DOI: 10.1016/j.gassur.2004.12.006.

Conlon K C, Labow D, Leung D, et al. Prospective randomized clinical trial of the value of intraperitoneal drainage after pancreatic resection[J]. Ann Surg, 2001, 234(4): 487-493. DOI: 10.1097/00000658-200110000-00008.

Van Buren G N, Bloomston M, Hughes S J, et al. A randomized prospective multicenter trial of pancreaticoduodenectomy with and without routine intraperitoneal drainage[J]. Ann Surg, 2014, 259(4): 605-612. DOI: 10.1097/SLA.dsjydxxb-39-10-101900460.

McMillan M T, Fisher W E, Van Buren G, et al. The value of drains as a fistula mitigation strategy for pancreatoduodenectomy: something for everyone? Results of a randomized prospective multi-institutional study[J]. J Gastrointest Surg, 2015, 19(1): 21-30; discussion 30-1. DOI: 10.1007/s11605-014-2640-z.

胡丙洋, 冷建军, 万涛, 等. 511例胰十二指肠切除术患者胰瘘危险因素分析[J].中华肝胆外科杂志, 2015, 21(6): 377-381. DOI: 10.3760/cma.j.issn.1007-8118.2015.06.005.

Hu B Y, Leng J J, Wan T, et al. Risk Factors of pancreatic fistula : a study on 511 patients after pancreaticoduodenectomy[J]. Chin J Hepatobiliary Surg, 2015, 21(6): 377-381. DOI:10.3760/cma.j.issn.1007-8118.2015.06.005.

王伟珅, 沈柏用, 邓侠兴, 等.胰十二指肠切除术后胰瘘的危险因素分析[J].中华消化外科杂志, 2014, 13(7): 531-534. DOI:10.3760/cma.j.issn.1673-9752.2014.07.008.

Wang W S, Shen B Y, Deng X X, et al. Risk factors of pancreatic fistula after pancreaticoduodenectomy[J]. Chinese Journal of Digestive Surgery, 2014, 13(7): 531-534. DOI:10.3760/cma.j.issn.1673-9752.2014.07.008.

Yamamoto Y, Sakamoto Y, Nara S, et al. A preoperative predictive scoring system for postoperative pancreatic fistula after pancreaticoduodenectomy[J]. World J Surg, 2011, 35(12): 2747-2755. DOI: 10.1007/s00268-011-1253-x.

Cecka F, Jon B, Lovecek M, et al. The role of drains in pancreatic surgery[J]. Rozhl Chir, 2014, 93(9): 450-455.

Fisher W E, Hodges S E, Silberfein E J, et al. Pancreatic resection without routine intraperitoneal drainage[J]. HPB (Oxford), 2011, 13(7): 503-510. DOI: 10.1111/j.1477-2574.2011.00331.x.

Correa-Gallego C, Brennan M F, D'Angolica M, et al. Operative drainage following pancreatic resection: analysis of 1122 patients resected over 5 years at a single institution[J]. Ann Surg, 2013, 258(6): 1051-1058. DOI: 10.1097/SLA.0b013e3182813806.

Nagakawa Y, Matsudo T, Hijikata Y, et al. Bacterial contamination in ascitic fluid is associated with the development of clinically relevant pancreatic fistula after pancreatoduodenectomy[J]. Pancreas, 2013, 42(4): 701-706. DOI: 10.1097/MPA.0b013e31826d3a41.

Pratt W B, Callery M P, Vollmer C M Jr. The latent presentation of pancreatic fistulas[J]. Br J Surg, 2009, 96(6): 641-649. DOI: 10.1002/bjs.6614.

Figueras J, Sabater L, Planellas P, et al. Randomized clinical trial of pancreaticogastrostomy versus pancreaticojejunostomy on the rate and severity of pancreatic fistula after pancreaticoduodenectomy [J]. British Journal of Surgery, 2013, 100(12): 1597-1605. DOI: 10.1002/bjs.9252.

Shrikhande S V, Barreto S G, Shetty G, et al. Post-operative abdominal drainage following major upper gastrointestinal surgery: single drain versus two drains[J]. J Cancer Res Ther, 2013, 9(2): 267-271. DOI: 10.4103/0973-1482.113380.

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