肝癌肝切除术后不放置腹腔引流管的初步探讨

Preliminary study of non-abdominal drainage after hepatectomy for primary liver cancer

目的探讨原发性肝癌(肝癌)肝切除术后不放置腹腔引流的可行性和安全性。方法回顾性分析2012年1月至2016年9月在广东省佛山市第一人民医院行肝切除术的201例肝癌患者临床资料。其中男172例,女29例;平均年龄(54±12)岁。患者均签署知情同意书,符合医学伦理学规定。根据有无放置腹腔引流管将患者分为非引流组(78例)和引流组(123例)。比较两组术后腹腔积液、胆漏、出血、腹腔感染等并发症发生情况。两组术中出血量、住院时间比较采用秩和检验,并发症发生率比较采用χ^2检验。结果非引流组术中出血量300(1450)ml,明显少于引流组的400(5970)ml(Z=-2.293,P<0.05);术后住院时间为8(23)d,亦明显短于引流组的10(63)d(Z=-2.132,P<0.05)。非引流组、引流组并发症发生率分别为36%(28/78)、41%(51/123),差异无统计学意义(χ^2=0.620,P>0.05);两组术后超声引导下介入治疗患者分别为4、13例,差异亦无统计学意义(χ^2=1.825,P>0.05)。两组均无发生术后30 d死亡。结论肝癌切除术后无需常规放置引流管,不放置腹腔引流管可缩短住院时间,促进患者快速康复。术中精细操作,严密止血,实施解剖性肝切除是术后安全的重要保障。术后需严密观察,必要时行介入治疗。

Objective To investigate the feasibility and safety of non-abdominal drainage after hepatectomy for primary liver cancer(PLC).Methods Clinical data of 201 PLC patients who underwent hepatectomy in the First People's Hospital of Foshan from January 2012 to September 2016 were retrospectively analyzed.Among them,172 patients were male and 29 female,aged(54±12)years on average.The informed consents of all patients were obtained and the local ethical committee approval was received.All patients were divided into the non-drainage(n=78)and drainage groups(n=123)according to whether abdominal drainage was performed.The incidence of postoperative complications,such as ascites,bile leakage,bleeding,and abdominal infection,were compared between two groups.Intraoperative bleeding volume and length of hospital stay were compared between two groups by using rank-sum test.The incidence of complications was analyzed by Chi-square test.Results In the non-drainage group,the intraoperative bleeding volume was 300(1450)ml,significantly less than 400(5970)ml in the drainage group(Z=-2.293,P<0.05).The length of postoperative hospital stay was 8(23)d in the non-drainage group,significantly shorter than 10(63)d in the drainage group(Z=-2.132,P<0.05).The incidence of complications in the nondrainage and drainage groups were 36%(28/78)and 41%(51/123)without significant difference(χ^2=0.620,P>0.05).In two groups,4 and 13 cases received postoperative ultrasound-guided interventional therapy respectively without significant difference(χ^2=1.825,P>0.05).No death occurred within postoperative 30 d in both group.Conclusions It is unnecessary to give routine abdominal drainage after hepatectomy for PLC.Non-abdominal drainage can shorten the length of hospital stay and accelerate recovery.Explicit operation,effective hemostasis and anatomical liver resection can guarantee the postoperative safety.Intimate observation is required after hepatectomy,and interventional treatment can be delivered if necessary.