腹腔镜肝切除术后不常规放置腹腔引流管的疗效分析

Efficacy of unconventional abdominal drainage after laparoscopic hepatectomy

目的探讨腹腔镜肝切除术后不常规放置腹腔引流管的有效性及安全性。方法回顾性收集2019年6月至12月期间因肝脏肿瘤在绵阳市中心医院行腹腔镜肝切除且符合本研究纳入条件患者的临床病理资料,根据术中是否放置腹腔引流管分为未放置腹腔引流管组(未置管组)和放置腹腔引流管组(置管组),比较2组患者手术相关及术后并发症(腹腔出血、胆汁漏、腹腔感染、肝功能衰竭)情况;然后再分别对肝癌和非肝癌患者未放置或放置腹腔引流管的术中、术后情况进行比较分析。结果本研究共收集符合纳入条件的患者117例,其中未置管组59例,置管组58例;肝癌组84例(未置管44例,置管40例),非肝癌组33例(未置管15例,置管18例)。①对总体患者而言,未置管组和置管组患者基线资料如性别、年龄、乙肝病毒感染、体质量指数、肝功能指标、肝硬度值、病种等比较差异均无统计学意义(P>0.05);未置管组较置管组术后下床活动时间和术后肛门排气时间均更早(P<0.001)、术后住院时间更短(P=0.030),但2组患者在其他指标比较差异均无统计学意义(P>0.05)。②无论是肝癌患者还是非肝癌患者,未置管患者较置管患者的术后下床活动时间和术后肛门排气时间均更早(P<0.001),在肝癌患者中未发现二者在术后住院时间方面的差别,而在非肝癌患者中发现未置管患者较置管患者的术后住院时间更短(P=0.042),其他指标在未置管患者及置管患者间比较差异均无统计学意义(P>0.05)。结论对于在技术娴熟的腹腔镜肝切除中心,腹腔镜肝切除术后有选择性地不常规放置腹腔引流管可能更有利于促进患者康复。

Objective To evaluate the safety and efficacy of unconventional abdominal drainage after laparoscopic hepatectomy.Methods The clinicopathologic data of patients who underwent laparoscopic hepatectomy for liver tumors in the Mianyang Central Hospital from June to December 2019 and met the inclusion criteria were retrospectively collected.Based on whether drainage tube was placed in the abdominal cavity during operation,the patients were divided into non-catheterized group(without drainage tube)and catheterized group(with drainage tube).The intraoperative data and postoperative complications(e.g.intraabdominal hemorrhage,bile leakage,abdominal infection,and liver failure)were compared between the two groups.Then,the intraoperative data and postoperative conditions of liver cancer and non-liver cancer patients with or without abdominal drainage tube were compared and analyzed.Results A total of 117 eligible patients were included in the study.The non-catheterized group had 59 patients and the catheterized group had 58 patients.The patients with liver cancer had 84 patients(44 non-catheterized patients and 40 catheterized patients)and the patients without liver cancer had 33 patients(15 non-catheterized patients and 18 catheterized patients).①On the whole,the groups were comparable in the baseline data between the non-catheterized group and the catheterized group,such as gender,age,HBV infection,body mass index,hepatic function index,liver stiffness value,disease category,etc.(P>0.05).Compared with the catheterized group,the non-catheterized group had earlier off-bed activities and earlier flatus time(P<0.001),and shorter postoperative hospital stay(P=0.030).However,no statistically significant differences were found in other indicators between the two groups(P>0.05).②Whether the patients had liver cancer or not,the non-catheterized patients still had earlier off-bed activities and earlier flatus time as compared with the catheterized patients(P<0.001).Among the patients with liver cancer,no difference was found in postoperative hospital stay.However,among the patients without liver cancer,the non-catheterized patients had shorter postoperative hospital stay than the catheterized patients(P=0.042).No statistically significant differences were found in other indicators between the catheterized patients and non-catheterized patients(P>0.05).Conclusion For technologically skilled laparoscopic hepatectomy center,selectively not placing peritoneal drainage tube after surgery might better promote the health of patients.