Pratt Wande B, Maithel Shishir K, Vanounou Tsafrir, Huang Zhen S, Callery Mark P, Vollmer Charles M
Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA.
Ann Surg. 2007 Mar;245(3):443-51. doi: 10.1097/01.sla.0000251708.70219.d2.
The authors sought to validate the ISGPF classification scheme in a large cohort of patients following pancreaticoduodenectomy (PD) in a pancreaticobiliary surgical specialty unit.
Definitions of postoperative pancreatic fistula vary widely, precluding accurate comparisons of surgical techniques and experiences. The ISGPF has proposed a classification scheme for pancreatic fistula based on clinical parameters; yet it has not been rigorously tested or validated.
: Between October 2001 and 2005, 176 consecutive patients underwent PD with a single drain placed. Pancreatic fistula was defined by ISGPF criteria. Cases were divided into four categories: no fistula; biochemical fistula without clinical sequelae (grade A), fistula requiring any therapeutic intervention (grade B), and fistula with severe clinical sequelae (grade C). Clinical and economic outcomes were analyzed across all grades.
More than two thirds of all patients had no evidence of fistula. Grade A fistulas occurred 15% of the time, grade B 12%, and grade C 3%. All measurable outcomes were equivalent between the no fistula and grade A classes. Conversely, costs, duration of stay, ICU duration, and disposition acuity progressively increased from grade A to C. Resource utilization similarly escalated by grade.
Biochemical evidence of pancreatic fistula alone has no clinical consequence and does not result in increased resource utilization. Increasing fistula grades have negative clinical and economic impacts on patients and their healthcare resources. These findings validate the ISGPF classification scheme for pancreatic fistula.
作者试图在一家肝胆胰外科专科单位的大量胰十二指肠切除术（PD）患者队列中验证国际胰腺外科研究组（ISGPF）的分类方案。
术后胰瘘的定义差异很大，这使得无法准确比较手术技术和经验。ISGPF提出了一种基于临床参数的胰瘘分类方案；然而，它尚未经过严格测试或验证。
2001年10月至2005年期间，176例连续患者接受了PD手术，并放置了单根引流管。根据ISGPF标准定义胰瘘。病例分为四类：无瘘；无临床后遗症的生化瘘（A级）、需要任何治疗干预的瘘（B级）和有严重临床后遗症的瘘（C级）。分析了所有分级的临床和经济结果。
超过三分之二的患者没有瘘的证据。A级瘘发生率为15%，B级为12%，C级为3%。无瘘组和A级组之间所有可测量的结果相当。相反，从A级到C级，成本、住院时间、重症监护病房停留时间和出院 acuity 逐渐增加。资源利用也随分级而相应增加。
仅胰瘘的生化证据没有临床后果，也不会导致资源利用增加。瘘分级增加对患者及其医疗资源有负面的临床和经济影响。这些发现验证了ISGPF的胰瘘分类方案。
