中国实用外科杂志

中国实用外科杂志 ›› 2024, Vol. 44 ›› Issue (04): 441-446.DOI: 10.19538/j.cjps.issn1005-2208.2024.04.15

• 特别推荐论著 • 上一篇    下一篇

胰十二指肠切除术后不同预防引流方案对结局的影响：一项回顾性多中心真实世界研究

徐林伟1，蔡云强2，高    松3，徐    强4，陈    伟5，张    曼2，宋宇宁3，李鹏禹4，于    玺5，李宏涛6，李    丹7，王    刚6，卫积书8，金佳斌7，张宇华1   

  1. 1浙江省肿瘤医院肝胆胰外科 中国科学院杭州医学研究所，浙江杭州 310022；2四川大学华西医院胰腺外科，四川成都 610041；3天津医科大学肿瘤医院胰腺肿瘤科，天津 300040；4北京协和医院基本外科，北京 100730；5中山大学附属第一医院胆胰外科，广东广州 510080；6哈尔滨医科大学附属第一医院胰胆外科，黑龙江哈尔滨 150081；7上海交通大学医学院附属瑞金医院普外科  胰腺疾病诊疗中心，上海 200025；8南京医科大学第一附属医院胰腺中心，江苏南京 211166
  • 出版日期:2024-04-01 发布日期:2024-05-07

  • Online:2024-04-01 Published:2024-05-07

摘要： 目的    探究胰十二指肠切除术（PD）术后不同预防引流方案对结局的影响。方法    回顾性分析2022年10—12月国内8家医院高流量胰腺外科中心医疗组（年胰腺手术量≥50例）收治的116例PD病例的临床资料。按照不同引流方案分为两管组（放置2根引流管，51例）和三管组（放置3根引流管，65例）。采用COX回归分析影响术后住院时间的因素，使用受试者工作特征曲线确定延长住院的最佳截止值；对两组进行倾向评分匹配（PSM）后采用Logistics回归分析影响延长住院的因素。结果    三管组病人术后住院时间短于两管组病人（HR=1.512，P=0.034）。通过ROC曲线分析，将术后住院时间>22 d定义为延长住院。经过倾向性评分匹配后两管组和三管组各32例，术后并发症、再入院、住院时间等预后相关指标组间差异无统计学意义，但延长住院的发生率差异有统计学意义［25.0%（8/32） vs. 3.1（1/32），P=0.026］；多因素回归分析结果示，放置3根引流管是延长住院的保护因素（OR=0.088，P=0.031）。结论    PD病人行预防性引流时放置引流管数量与延长住院相关，更充分的引流可能改善病人结局。

关键词: 胰十二指肠切除术, 引流, 住院时间

Abstract: The impact of different postoperative drainage strategies on outcomes in pancreaticoduodenectomy: A retrospective multicenter real-world study        XU Lin-wei*，CAI Yun-qiang，GAO Song，et al. Department of Hepatobiliary-Pancreatic Surgery，Zhejiang Cancer Hospital，& Hangzhou Institute of Medicine(HIM)，Chinese Academy of Sciences，Hangzhou 310022，China 
Corresponding authors：WANG Gang，E-mail：wgilu79@163.com；WEI Ji-shu，E-mail：weijishu@njmu.edu.cn；JIN Jia-bin，E-mail：jjb11501@rjh.com.cn；ZHANG Yu-hua，E-mail：zhangyuhua1013@126.com
XU Lin-wei，CAI Yun-qiang，GAO Song，XU Qiang，CHEN Wei are the first authors who contributed equally to the article
Abstract    Objective    To investigate the impact of different postoperative drainage strategies on outcomes following pancreaticoduodenectomy (PD). Methods    Clinical data of 116 PD cases admitted to the medical group of high-flow pancreatic surgery centres (annual pancreatic surgery volume ≥50 cases) in eight hospitals in China from October to December 2022 were retrospectively analysed.  Patients were divided into two groups based on different drainage strategies: the two-tube group (51 cases with placement of 2 drainage tubes) and the three-tube group (65 cases with placement of 3 drainage tubes). COX regression analysis was used to identify factors influencing postoperative length of hospital stay, and the receiver operating characteristic (ROC) curve was used to determine the optimal cutoff value for prolonged hospitalization.  Logistic regression analysis was performed to identify factors influencing prolonged hospitalization after propensity score matching (PSM) of the two groups. Results    Three-tube group patients had a shorter postoperative hospital stay compared to two-tube group patients (HR=1.512, P=0.034).  Based on ROC curve analysis, postoperative hospital stay >22 days was defined as prolonged hospitalization. After propensity score matching, there were 32 cases in the two-tube group and the three-tube group, there was no statistically significant difference between groups in prognosis-related indicators，but there is a statistically significant difference in the incidence of prolonged hospitalization［25.0%（8/32） vs. 3.1%（1/32），P=0.026］; Multivariate regression analysis showed that placement of three drainage tubes was a protective factor for prolonged hospitalization (OR=0.088, P=0.031). Conclusion    The number of drains placed when prophylactic drainage is performed in PD patients is associated with prolonged hospitalisation, and more adequate drainage may improve patient outcomes.

Key words: multicenter study；pancreaticoduodenectomy；drainage；hospitalization time