Optimal drainage area of abdominal cavity after pancreatoduodenectomy： a prospective cohort study

Li Qinyi; Zhang Xianhe; Tai Guokai; Li Fei; Wang Zhidong

doi:10.3969/j.issn.1003-5591.2025.01.007

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Optimal drainage area of abdominal cavity after pancreatoduodenectomy： a prospective cohort study

更新时间：2026-11-05

- Optimal drainage area of abdominal cavity after pancreatoduodenectomy： a prospective cohort study
- J Abdominal Surg Vol. 38, Issue 1, Pages: 30-36(2025)
- 作者机构：
  
  哈尔滨医科大学附属第二医院胆胰外科，黑龙江哈尔滨 150086
- 作者简介：
  
  Wang Zhidong， Email：wzd98y2@163.com
- 基金信息：
- DOI：10.3969/j.issn.1003-5591.2025.01.007
  CLC： R61;R657.5
- Received：04 December 2024，
  
  Published：22 February 2025
- 稿件说明：
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李秦屹,张显赫,邰国凯等.胰十二指肠切除术后腹腔最佳引流区域的前瞻性队列研究[J].腹部外科,2025,38(01):30-36.

Li Qinyi,Zhang Xianhe,Tai Guokai,et al.Optimal drainage area of abdominal cavity after pancreatoduodenectomy： a prospective cohort study[J].J Abdominal Surg,2025,38(01):30-36.
李秦屹,张显赫,邰国凯等.胰十二指肠切除术后腹腔最佳引流区域的前瞻性队列研究[J].腹部外科,2025,38(01):30-36. DOI： 10.3969/j.issn.1003-5591.2025.01.007.

Li Qinyi,Zhang Xianhe,Tai Guokai,et al.Optimal drainage area of abdominal cavity after pancreatoduodenectomy： a prospective cohort study[J].J Abdominal Surg,2025,38(01):30-36. DOI： 10.3969/j.issn.1003-5591.2025.01.007.

摘要

目的

研究胰十二指肠切除术（pancreaticoduodenectomy，PD）术后腹腔积液最容易蓄积的区域。

方法

该项是前瞻性队列研究，收集哈尔滨医科大学附属第二医院2022年10月至2024年8月期间收治的106例行PD病人的术后引流情况、术后腹水淀粉酶指标以及术后CT等影像学资料，依据PD术后腹腔引流放置区域不同分为Ⅰ组、Ⅱ组和Ⅲ组（第Ⅱ组与第Ⅰ组区别在于将第2根引流管从胰肠吻合口头侧放置于胰肠吻合口背侧，第Ⅰ组与第Ⅲ组的区别是第Ⅰ组在第Ⅲ组的基础上增加了1根引流胰肠吻合口腹侧区域的引流管），其中Ⅰ组28例，Ⅱ组33例，Ⅲ组45例。比较3组中各区域术后引流、腹腔积液情况以及腹水淀粉酶指标。先进行正态性Shapiro-Wilk检验，对于服从或近似正态分布的计量资料采用

±s表达，采用

检验；对于不符合正态性分布的连续变量，采用

（

，

）表达；计数资料的组间比较采用

检验；不同时间、组间的交互作用下水平采用重复测量方差分析，多组间（3组及3组以上）比较采用单因素方差分析。

结果

在术后总积液量方面，Ⅰ组中胆肠吻合口区域（A区域）最少［（239.08±168.68） mL］，胰肠吻合口头侧区域（B区域）最多［（627.32±195.56） mL］，差异有统计学意义（

＜0.05）；Ⅱ组中A区域最少［（227.52±129.35） mL］，胰肠吻合口背侧区域（D区域）最多［（646.19±250.92） mL］，差异有统计学意义（

＜0.05）；而Ⅲ组中A区域［（111.83±52.62） mL］少于B区域［（563.12±275.73） mL］，差异有统计学意义（

＜0.05）。在腹水淀粉酶值方面，Ⅰ组中A区域最低［40.5（15.75，104.5） U/L］，胰肠吻合口腹侧区域（C区域）最高［

187.5（58.5，2 118.25） U/L］，差异有统计学意义（

＜0.05）；Ⅱ组中A区域最低［88.0（29.5，173.0） U/L］，C区域［510.0（65.0，1 850.0） U/L］和D区域［406.0（75.5，1 342.5） U/L］均较高，三者间差异有统计学意义（

＜0.05），C区域与D区域间差异无统计学意义（

＞0.05）；Ⅲ组中A区域［75.0（33.5，344.5） U/L］低于B区域［409.0（79.5，898.0） U/L］，差异有统计学意义（

＜0.05）。

结论

PD术后胰肠吻合口头侧区域因位置较低以及清扫多组淋巴结其蓄积的腹腔积液最多，胰肠吻合口腹侧和背侧区域因靠近胰肠吻合口其腹水淀粉酶值均较高，胰肠吻合口头侧区域建议术后常规放置预防性引流管，胰瘘风险较大的病人建议在胰肠吻合口腹侧区域放置1根引流管。

Abstract

Objective

To investigate the areas where postoperative abdominal fluid is most likely to accumulate after pancreaticoduodenectomy （PD）.

Methods

Postoperative drainage， ascitic amylase levels， and postoperative imaging data， including CT scans in 106 patients who underwent PD at the 2nd Hospital of Harbin Medical University between October 2022 and August 2024 were prospectively analyzed. Patients were categorized into three groups based on the placement of abdominal drains： Group Ⅰ， Group Ⅱ， and Group Ⅲ. The difference between Group Ⅰ and Group Ⅱ was the placement of the second drainage tube， which in Group Ⅱ was positioned at the dorsal side of the pancreaticojejunostomy， and the oral side in Group Ⅰ. The difference between Group Ⅰ and Group Ⅲ was the placement of an additional drain at the ventral side of the pancreaticojejunostomy in Group Ⅰ. Finally， Group Ⅰ consisted of 28 patients， Group Ⅱ had 33 patients， and Group Ⅲ included 45 patients. Postoperative drainage， abdominal fluid accumulation， and ascitic amylase levels were compared across these groups. The Shapiro-Wilk test was performed for testing the normality. Continuous variables that followed or approximately followed a normal distribution were expressed as

， and compared by the t-test. Continuous variables did not conform to a normal distribution were expressed as median （

，

） and compared by the chi-square test. Repeated measures analysis of variance （ANOVA） was applied to assess the interaction effects across different time points and groups. For comparisons among three or more groups， one-way ANOVA was used.

Results

Group Ⅰ showed the least total postoperative fluid accumulation in the biliary-enteric anastomosis （region A）（239.08±168.68 mL） and the most fluid accumulation in the head side of the pancreatic-enteric anastomosis （region B）（627.32±195.56 mL）（

0.05）. In Group Ⅱ， the least total postoperative fluid accumulation was found in region A （227.52±129.35 mL）， and the most accumulation was detected in the back side of the pancreatic-enteric anastomosis （region D）（646.19±250.92 mL）（

0.05）. In Group Ⅲ， a significant less total postoperative fluid accumulation was found in region A （111.83±52.62 mL） than region B （563.12±275.73 mL）（

0.05）. In Group Ⅰ， the lowest ascitic amylase index was detected in region A ［40.5 （15.75， 104.5） U/L］， and the highest was detected in the ventral side of the pancreatic-enteric anastomosis （region C）［187.5 （58.5，2 118.25） U/L］（

0.05）. The lowest ascitic amylase index in Group Ⅱ was detected in region A ［88.0 （29.5， 173.0） U/L］， and the higher value was detected in region C ［510.0 （65.0， 1 850.0） U/L］ and region D ［406.0 （75.5， 1 342.5） U/L］，There is a statistically significant difference between the three regions （

0.05）. However， no significant difference was observed between regions C and D （

0.05）. In Group Ⅲ， the ascitic amylase index was significantly lower in region A ［75.0 （33.5， 344.5） U/L］ than region B ［409.0 （79.5， 898.0） U/L］（

0.05）.

Conclusion

The area on the oral side of the pancreaticojejunostomy tends to accumulate the most abdominal fluid after PD， due to its lower position and the dissection of multiple lymph nodes.The amylase levels in the ascitic fluid are higher in both the ventral and dorsal regions near the pancreaticojejunostomy.Therefore，it is recommended to routinely place a prophylactic drainage tube in the oral side of the pancreaticojejunostomy.For patients at higher risk of pancreatic fistula，it is advisable to place an additional drainage tube in the ventral region of the pancreaticojejunostomy.

关键词

Keywords

references

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