冲-引分体引流管在胰腺术后预防并发症的临床疗效

Clinical efficacy of douching-draining separate drainage tube in the prevention of complications after pancreatic surgery

背景与目的:术后并发症是影响胰腺手术患者预后的重要因素,留置腹腔引流管是减少术后并发症发生的常规操作,目前引流管的种类繁多、效果差异较大,本研究介绍一种自制冲-引分体引流管的使用方法,并探讨其临床应用效果。方法:回顾性分析2021年1月1日—2023年7月1日,中国人民解放军海军军医大学第一附属医院肝胆胰脾外科实施的213例胰十二指肠切除术(PD)和远端胰腺切除术(DP)患者的临床资料,所有患者均应用自制冲-引分体引流管。对两种术式达到教科书式结局(TO)的比例、术后各并发症与严重并发症(Clavien-Dindo并发症分级≥Ⅲ级)的发生率、术后住院时间、30 d内再入院率,以及30、90 d内病死率等情况进行统计分析,并与相关文献资料对比。结果:213例患者中,143例行PD,70例行DP,两种术式的TO率分别为69.2%(99/143)和81.4%(57/70)。行PD患者30、90 d内病死率均为0.7%(1/143),而行DP患者30、90 d内病死率均为0 (0/70)。行PD和DP患者的胰瘘(B/C级)发生率分别为9.8%(14/143)和8.6%(6/70)、胆汁漏(B/C级)发生率分别为4.2%(6/143)和0 (0/70)、术后出血(B/C级)发生率分别为6.3%(9/143)和0 (0/70)、胃排空障碍(B/C级)发生率分别为7.7%(11/143)和2.9%(2/70),严重并发症发生率分别为18.2%(26/143)和7.1%(5/70);术后住院时间分别为11 (9~14) d与7 (6~10) d;30 d内再入院率分别为9.8%(14/143)和7.1%(5/70)。与相关文献比较,本组患者的TO率较高,30、90 d内病死率降低,术后胰瘘、胆汁漏、术后出血、胃排空障碍与严重并发症发生率,以及30 d内再入院率降低。结论:胰腺术后使用自制冲-引分体引流管可以相对提高TO率,有效降低围手术期死亡及相关并发症与严重并发症的发生率,以及30 d内再入院率,提高患者围手术期安全性,对患者的术后恢复和预后具有积极意义。

Background and Aims:Postoperative complications are important factors affecting the prognosis of patients undergoing pancreatic surgery.An abdominal drainage tube placement is a routine procedure to reduce postoperative complications.Currently,there are various types of drainage tubes with significant differences in efficacy.This study was to introduce a method of using a self-made douching-draining separate drainage tube and explore its clinical application effects.Methods:The clinical data of 213 patients who underwent pancreaticoduodenectomy(PD) or distal pancreatectomy(DP) performed by the author's team from the Department of Hepatopancreatobiliary and Splenic Surgery,the First Affiliated Hospital of Naval Medical University from January 1,2021 to July 1,2023 were retrospectively analyzed.All patients were treated with the self-made douchingdraining separate drainage tube.The proportion of textbook outcome(TO) achieved in both procedures,the incidence rates of postoperative specific complications and severe complications(Clavien-Dindo complications classification grade≥Ⅲ),postoperative hospital stay,30-d readmission rate,and 30-d and 90-d mortality rates were statistically analyzed and compared with relevant literature.Results:Among the 213 patients,143 underwent PD,and 70 underwent DP,with TO rates of 69.2%(99/143) and 81.4%(57/70),respectively.The 30-d and 90-d mortality rates for PD patients were 0.7%(1/143),while for DP patients,both were 0(0/70).The incidence of pancreatic fistula(grade B/C) in PD and DP patients was 9.8%(14/143) and 8.6%(6/70),respectively,bile leakage(grade B/C) occurred in 4.2%(6/143) and 0(0/70),postoperative hemorrhage(grade B/C) occurred in 6.3%(9/143) and 0(0/70),gastric emptying disorder(grade B/C) occurred in 7.7%(11/143) and 2.9%(2/70),and the incidence of severe complications was 18.2%(26/143) and 7.1%(5/70),respectively.The postoperative hospital stays were 11(9-14) d and 7(6-10) d for PD and DP patients,respectively,and the 30-d readmission rates were 9.8%(14/143) and 7.1%(5/70),respectively.Compared with relevant literature,the TO rate of patients in this group was higher,with decreased 30-d and 90-d mortality rates,decreased incidence of postoperative pancreatic fistula,bile leakage,postoperative hemorrhage,gastric emptying disorder,severe complications,and 30-d readmission rates.Conclusion:Using a self-made douching-draining separate drainage tube after pancreatic surgery can relatively increase the TO rate,effectively reduce perioperative mortality and the incidence of related complications and severe complications,as well as the 30-d readmission rate,thereby improving the perioperative safety of patients.It has a positive significance for postoperative recovery and patient prognosis.