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在胰腺手术中的腹腔排水以证据为基础的方法:系统审查和元分析
Rohith Kodali1, Kunal Parasar2, Utpal Anand1
1Department of Surgical Gastroenterology, All India Institute of Medical Sciences, Patna 801507, Bihar, India.
在胰腺手术后进行常规的手术排水并不能改善结果,并且可能增加胰腺瘤和延迟胃排空等风险. 建议提前清除排水以减少患者的发病率.
科学领域:
- 胃肠病学
- 外科瘤学
- 腹部手术
背景情况:
- 从历史上看, 在胰腺手术后,
- 最近的证据引发了关于这些程序中常规使用排水管的争论.
研究的目的:
- 在胰腺手术中评估腹腔排水的必要性.
- 确定最佳的排水类型和移除时间.
- 评估对患者结果的影响.
主要方法:
- 在2023年12月之前对多个电子数据库进行系统审查.
- 在选了1910篇文章后,包括了48篇研究.
- 分析主要结果,包括临床相关的术后胰腺 (CR-POPF) 和延迟的胃排空 (DGE).
主要成果:
- 常规排水使用显示CR-POPF和DGE风险显著增加.
- 没有排水的患者患病率降低,重新入院和重复手术.
- 主动排水和被动排水之间没有区别;提前清除 (<3天) 改善了结果.
结论:
- 胰腺切除后的常规排水没有任何好处,可能会增加发病率/死亡率.
- 外科医生应该根据个人情况做出排水决定.
- 早期排水可显著缓解术后并发症.
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