臨床外科69巻6号

2014年06月発行

臨床の疑問に答える「ドクターAのミニレクチャー」・25

予防的ドレーン―消化器手術のドレーンは必要か

著者： 安達洋祐¹

所属機関： ¹久留米大学医学部外科

ページ範囲：P.732 - P.735

文献概要

素朴な疑問

　開腹手術では腹腔内にドレーンを置くことが多い．ドレーンの目的は術後合併症の発見や予防であるが，最近は感染に留意して閉鎖式吸引ドレーンが主流であり，多くのドレーンはあたかも無用であったかのように抜去される．消化器の手術では必ずドレーンを置かないといけないのだろうか．ドレーンを置かないと術後合併症が増えるのだろうか．

参考文献

1）Yamaguchi S（Japan）：Prophylactic and informational abdominal drainage is not necessary after colectomy and suprapromontory anastomosis. Int Surg 98：307-310, 2013

2）Yamazaki S（Japan）：Criteria for drain removal following liver resection. Br J Surg 99：1584-1590, 2012

3）Tanaka K（Japan）：The effectiveness and appropriate management of abdominal drains in patients undergoing elective liver resection：a retrospective analysis and prospective case series. Surg Today 43：372-380, 2013

4）Kawai M（Japan）：Early removal of prophylactic drains reduces the risk of intra-abdominal infections in patients with pancreatic head resection：prospective study for 104 consecutive patients. Ann Surg 244：1-7, 2006

5）Kurahara H（Japan）：Indicators of complications and drain removal after pancreatoduodenectomy. J Surg Res 170：211-216, 2011

6）Merad F（France）：Is prophylactic pelvic drainage useful after elective rectal or anal anastomosis? A multicenter controlled randomized trial. Surgery 125：529-535, 1999

7）Tzovaras G（Greece）：Is there a role for drain use in elective laparoscopic cholecystectomy? A controlled randomized trial. Am J Surg 197：759-763, 2009

8）Sun HC（China）：Randomized clinical trial of the effects of abdominal drainage after elective hepatectomy using the crushing clamp method. Br J Surg 93：422-426, 2006

9）Liu CL（Hong Kong）：Abdominal drainage after hepatic resection is contraindicated in patients with chronic liver diseases. Ann Surg 239：194-201, 2004

10）Bassi C（Italy）：Early versus late drain removal after standard pancreatic resections：results of a prospective randomized trial. Ann Surg 252：207-214, 2010

11）Urbach DR（Canada）：Colon and rectal anastomoses do not require routine drainage：a systematic review and meta-analysis. Ann Surg 229：174-180, 1999

12）Petrowsky H（Switzerland）：Evidence-based value of prophylactic drainage in gastrointestinal surgery：a systematic review and meta-analyses. Ann Surg 240：1074-1084, 2004

13）Wang Z（China）：Abdominal drainage versus no drainage post-gastrectomy for gastric cancer. Cochrane Database Syst Rev, 8, CD008788, 2011

14）Jesus EC（Brazil）：Prophylactic anastomotic drainage for colorectal surgery. Cochrane Database Syst Rev, 4, CD002100, 2004

15）Gurusamy KS（UK）：Routine abdominal drainage for uncomplicated liver resection. Cochrane Database Syst Rev, 3, CD006232, 2007

16）Gurusamy KS（UK）：Routine abdominal drainage versus no abdominal drainage for uncomplicated laparoscopic cholecystectomy. Cochrane Database Syst Rev, 9, CD006004, 2013

17）Van Buren G（USA）：A randomized prospective multicenter trial of pancreaticoduodenectomy with and without routine intraperitoneal drainage. Ann Surg 259：605-612, 2014

18）Deng B（China）：Suction or non-suction to the underwater seal drains following pulmonary operation：meta-analysis of randomised controlled trials. Eur J Cardiovasc Surg 38：210-215, 2010

19）Luckraz H（UK）：Is an intercostal chest drain necessary after video-assisted thoracoscopic（VATS）lung biopsy? Ann Thorac Surg 84：237-239, 2007

20）Krishnamoorthy B（UK）：Closed suction drainage improves clinical outcome in patients undergoing endoscopic vein harvesting for coronary artery bypass grafting. Ann Thorac Surg 93：1201-1205, 2012

21）Karthikesalingam A（UK）：Efficacy of closed suction drainage in lower limb arterial surgery：a meta-analysis of published clinical trials. Vasc Endovasc Surg 42：243-248, 2008

22）Thomson DR（UK）：Wound drainage after axillary dissection for carcinoma of the breast. Cochrane Database Syst Rev, 10, CD006823, 2013

23）Classe JM（France）：Randomized clinical trial comparing axillary padding with closed suction drainage for the axillary wound after lymphadenectomy for breast cancer. Br J Surg 93：820-824, 2008

24）Barton A（Canada）：Early removal of postmastectomy drains is not beneficial：results from a halted randomized controlled trial. Am J Surg 191：652-656, 2006

25）Stojkovic CA（Netherlands）：Wound drainage after plastic and reconstructive surgery of the breast. Cochrane Database Syst Rev, 3, CD007258, 2013