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中国临床研究英文版:2017,30(9):1157-1161
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老年原发性肝癌患者术后是否需要预置腹腔引流管的探讨
(1.东南大学医学院附属徐州医院 东南大学(徐州)肿瘤研究所肿瘤外科,江苏 徐州 221000;2.南京医科大学第一附属医院肝脏外科,江苏 南京 210029)
Is postoperative preset abdominal drainage tube necessary in elderly patients with primary hepatic carcinoma
摘要
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Received:April 02, 2017   Published Online:March 23, 2018
中文摘要: 目的:评估老年原发性肝癌患者术后是否需要预置腹腔引流管。方法:回顾性分析2011年1月至2016年12月东南大学医学院附属徐州医院肿瘤外科因原发性肝癌而行手术治疗的老年患者的临床资料,根据是否预置腹腔引流管分为两组,比较预置腹腔引流管与否对患者术后并发症的影响。结果:共有97例患者符合入组标准,其中65例患者放置腹腔引流管,32例患者不放置腹腔引流管。预置腹腔引流管组中有33例(50.8%,33/65)患者出现47例次不同类型并发症,而不预置腹腔引流管组中有7例(21.9%,7/32)患者出现8例次不同类型并发症,两组之间差异有统计学意义(P<0.05)。在预置腹腔引流管组中,术后腹腔引流管口渗液(36.9%)为最常见的并发症,其他依次为手术切口感染(9.2%)、胸腔积液(7.7%)、膈下积液(4.6%)和腹腔感染(4.6%),而胆漏和腹腔出血均只有1例发生(1.5%)。在不预置腹腔引流管组中,其最常见的并发症分别是手术切口感染(6.2%)、胸腔积液(6.2%)以及膈下积液(6.2%),并未发现腹腔出血及胆漏的病例。预置腹腔引流管组术后住院天数明显高于不预置腹腔引流管组[(14.17±3.37)d vs(10.66±1.68)d,P<0.05]。Logistic多因素回归分析显示:放置引流管、肝功能Child-Pugh分级B级以及大范围肝切除术是肝癌患者术后发生并发症的独立危险因素(P<0.05,P<0.01)。结论:原发性肝癌术后没有必要预置腹腔引流管。
Abstract:Objective To evaluate the necessity of postoperative preset abdominal drainage tube in elderly patients with primary hepatic carcinoma. Methods Clinical data was retrospectively analyzed in elderly patients who received hepatectomy due to primary hepatic carcinoma from January 2011 to December 2016 in Affiliated Xuzhou Hospital of Southeast University. According to whether the abdominal drainage tube was preset, all patients were divided into two groups. The postoperative complications of the two groups were observed. Results A total of 97 patients met the group standard, of which 65 patients preset abdominal drainage tubes (preset group), and 32 patients did not preset the tube (no preset group). In preset group, there were 33 patients had 47 case-times complications(50.8%, 33/65), at the mean time there were 8 case-times complications of 7 patients in no preset group (21. 9%, 7/32), the difference between two groups was statistically significant (P<0.05). Exudate of drainage tube incision was the most common complication (36. 9%) in the preset group, followed by surgical incision infection (9. 2%), pleural effusion (7. 7%), sub phrenic effusion (4. 6%) and abdominal infection (4. 6%), and bile fistula and abdominal bleeding were only 1 case each (1. 5%). In the no preset group, the most common complications were surgical incision infection (6. 3%), pleural effusion (6. 3%), and sub phrenic effusion (6. 3%), and there was no case of abdominal bleeding and bile fistula. The length of postoperative hospital stay in preset group was longer than that in the no preset group [(14. 17±3. 37) d vs (10.66±1. 68) d, P<0.05]. Logistic multivariate regression analysis showed that preset of drainage tube, liver function Child-Pugh grade B and extensive hepatectomy were independent risk factors for postoperative complications in elderly patients with hepatic carcinoma (P<0.05, P<0.01). Conclusion It′s not necessary to postoperative preset abdominal drainage tube in elderly patients with primary hepatic carcinoma.
文章编号:     中图分类号:R735.7    文献标志码:A
基金项目:国家自然科学基金(81400650);徐州市科技项目(KC16SH039)
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