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  

The impact of different postoperative drainage strategies on outcomes in pancreaticoduodenectomy:A retrospective multicenter real-world study

作　　者：徐林伟 蔡云强[2] 高松 徐强[4] 陈伟[5] 张曼 宋宇宁 李鹏禹 于玺 李宏涛 李丹 王刚[6] 卫积书 金佳斌[7] 张宇华 XU Lin-wei;CAI Yun-qiang;GAO Song(Department of Hepatobiliary-Pancreatic Surgery,Zhejiang Cancer Hospital,&Hangzhou Instilute of Medicine(HIM),Chinese Academy of Sciences,Hangzhou 310022,China;不详)

机构地区：[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　　处：《中国实用外科杂志》2024年第4期441-446,共6页Chinese Journal of Practical Surgery

基　　金：国家自然科学基金项目(No.82370651,No.82070657)。

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。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.

关 键 词：胰十二指肠切除术 引流 住院时间 

分 类 号：R6[医药卫生—外科学]