基于倾向性评分匹配探讨微创小范围肝切除术未预防性放置腹腔引流管的安全性

Propensity score matching study of the feasibility of no-prophylactic abdominal drainage strategy for the minimally invasive minor hepatectomy

目的基于倾向性评分匹配(PSM)探讨行微创小范围肝切除术患者术中未预防性放置腹腔引流管的安全性。方法回顾性分析2022年6月至2023年5月在浙江省人民医院肝胆胰外科、微创外科行腹腔镜或机器人辅助小范围肝切除手术患者的临床资料。共纳入108例患者,其中男性48例,女性60例,年龄(60.8±13.7)岁。根据术中是否预防性放置腹腔引流管,分为两组:预防性放置腹腔引流管的76例患者为引流组;未预防性放置腹腔引流管的32例患者为非预防引流组。采用PSM比较两组患者的肝切除范围、术中出血量、手术时间、并发症等围手术期资料。术后采用电话咨询对患者进行随访,记录患者术后90 d内的生存情况。结果PSM前,引流组和非预防引流组患者在年龄、高血压病史方面差异存在统计学意义(均P<0.05)。进行PSM,46例配对成功,引流组和非预防引流组各23例。PSM后,两组患者的手术方式、病灶病理类型、病灶数目、病灶最大径、肝切除范围、肝切除难度评分、肝门阻断时间等术中指标差异均无统计学意义(均P>0.05)。两组患者术后均无腹腔出血发生,两组患者在术后发热、胆漏、切口感染、术后再穿刺发生率等方面差异均无统计学意义(均P>0.05)。PSM后,与非预防引流组患者相比,引流组患者术后第1天白细胞计数降低[9.39(6.30,10.58)×10^(12)/L比13.19(10.15,14.90)×10^(12)/L]、术后住院时间缩短[4(3,5)d比5(4,5)d],差异均具有统计学意义(均P<0.05)。两组患者术后90 d内均无死亡病例。结论微创小范围肝切除手术不预防性放置腹腔引流管是安全可行的,并未增加术后发热、肝周积液及再穿刺引流的发生率,有助于术后快速康复。

ObjectiveTo evaluate the feasibility of abandoning prophylactic abdominal drainage in patients undergoing minimally invasive minor hepatectomy based on a propensity score matching(PSM)study.MethodsRetrospective review of a prospectively collected database of patients undergoing minimally invasive minor hepatectomy from July 2022 to May 2023 at the Department of Hepatopancreatobiliary Surgery and Minimally Invasive Surgery,Zhejiang Provincial People's Hospital.A total of 108 patients were enrolled,including 48 males and 60 females,aged(60.8±13.7)years old.According to whether the abdominal drainage tube was prophylactically placed intraoperatively,patients were divided into two groups:the drainage group(with prophylactic placement of abdominal drainage tubes,n=76);the no-drainage group(without prophylactic placement of abdominal drainage tubes,n=32).PSM was used to compare the perioperative data between the groups,including extent of liver resection,intraoperative blood loss,operative time,and postoperative complications.Postoperative survival status within 90 days was followed up through telephone review.ResultsBefore PSM,the two groups differed significantly on age and the history of hypertension(both P<0.05).After PSM,there were 23 patients in each group.Patients in the two groups showed comparable results regarding the intraoperative parameters including the surgical method,pathological types,the number and maxium diameter of hepatic lesions,the extent and complexity of liver resection,and the duration of hepatic inflow occlusion(all P>0.05).No postoperative intra-abdominal bleeding occurred in either group.The incidences of postoperative complications were comparable between the groups,including fever,bile leakage,incision infection,and abdominal acupuncture for drainage(all P>0.05).After PSM,compared to patients wothout prophylactic abdominal drainage,prophylactic abdominal drainage group showed a decreased white blood cell counts on postoperative day 1[9.39(6.30,10.58)×10^(12)/L vs.13.19(10.15,14.90)×10^(12)/L,P=0.006]and a shorter length of postoperative hospital stay[4(3,5)d vs.5(4,5)d,P=0.033].No postoperative death within 90 days occurred in either group.ConclusionIn minimally invasive minor hepatectomy,abandoning prophylactic abdominal drainage could be feasible,which facilitates fast recovery without increasing the incidence of postoperative fever,perihepatic fluid accumulation and postoperative abdominal acupuncture for drainage.