在左胰腺切除术后重新考虑腹部排水 - 随机对照PANDRA II试验
Joerg Kaiser1, Willem Niesen1, Ulf Hinz1
1Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Germany.
Annals of surgery
|February 5, 2025
概括
在左胰腺切除术 (LP) 后不进行常规的腹部排水,对于患者的发病率来说,不逊色于排水. 这种方法可显著降低LP手术后的整体并发症率.
科学领域:
- 胃肠道学和肝胆道外科
- 手术瘤学手术瘤学
- 临床试验和基于证据的医学
背景情况:
- 左胰腺切除术 (LP) 后的常规腹腔内排水是预防术后胰腺囊 (POPF) 等并发症的传统做法.
- 新出现的证据质疑常规排水的必要性,表明忽略其可能带来潜在的好处.
研究的目的:
- 评估与LP后的使用相比,省略常规腹部排水的非劣势性.
- 评估排水对整体术后发病率和特定并发症的影响.
主要方法:
- 潘德拉II试验是一个随机对照的非劣等性研究.
- 接受开放式或微创性LP的患者被分配到带有或没有腹部排水的组.
- 主要终点是整体术后发病率,用综合并发症指数 (CCI) 来衡量.
主要成果:
- 省略排水在CCI方面与常规排水相比没有劣势 (13.90对19.43,P<0.001为非劣势).
- 没有排水组的整体并发症率明显较低 (50.41%vs78.40%,P<0.001).
- 两组之间没有观察到POPF或胰腺切除术后出血率的显著差异.
结论:
- 在LP后省略常规腹部排水是一种安全有效的策略,在患病率方面表明对排水无劣.
- 放弃常规排水导致左胰腺切除术后整体并发症率显著降低.
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