Department of Hepato-Pancreato-Biliary Surgery, Pôle des Maladies de l'Appareil Digestif (PMAD), Paris, France.
Surgery. 2010 Jul;148(1):15-23. doi: 10.1016/j.surg.2009.12.005.
Pancreatic fistula (PF) after pancreatoduodenectomy (PD) remains a challenging problem. The only commonly accepted risk factor is the soft consistency of the pancreatic remnant.
In all, 100 consecutive patients underwent PD. All data, including commonly accepted risk factors for PF and PF defined according to the International Study Group of Pancreatic Fistula, were collected prospectively. On the pancreatic margin, a score of fibrosis and a score of fatty infiltration were assessed by a pathologist blinded to the postoperative course.
PF occurred in 31% of patients. In univariate analysis, male sex, age greater than 58 years, body mass index (BMI) > or =25 kg/m(2), pre-operative high blood pressure, operation for nonintraductal papillary and mucinous neoplasm (IPMN) disease and for ampullary carcinoma, operative time, blood loss, soft consistency of the pancreatic remnant, absence of pancreatic fibrosis, and presence of fatty infiltration of the pancreas were associated with a greater risk of PF. In a multivariate analysis, only BMI > or =25 kg/m(2), absence of pancreatic fibrosis, and presence of fatty pancreas were significant predictors of PF. A score based on the number of risk factors present divided the patient population into 4 subgroups carrying a risk of PF that ranged from 7% (no risk factor) to 78% (3 risk factors) and from 0% to 81%, taking into account only symptomatic PF (grade B and C).
The presence of an increased BMI, the presence of fatty pancreas, and the absence of pancreatic fibrosis as risk factors of PF allows a more precise and objective prediction of PF than the consistency of pancreatic remnant alone. A predictive score based on these 3 factors could help to tailor preventive measures.
胰十二指肠切除术后（PD）发生胰瘘（PF）仍然是一个具有挑战性的问题。唯一被普遍接受的风险因素是胰腺残端质地柔软。
共有 100 例连续患者接受 PD。所有数据，包括 PF 的常见公认风险因素和根据国际胰腺瘘研究组定义的 PF，均前瞻性收集。在胰腺切缘，病理学家对纤维化评分和脂肪浸润评分进行盲法评估，不了解术后过程。
31%的患者发生 PF。单因素分析显示，男性、年龄大于 58 岁、体重指数（BMI）大于或等于 25kg/m(2)、术前高血压、非导管内乳头状和黏液性肿瘤（IPMN）疾病和壶腹癌行手术、手术时间、出血量、胰腺残端质地柔软、无胰腺纤维化以及胰腺脂肪浸润与 PF 风险增加相关。多因素分析显示，仅 BMI 大于或等于 25kg/m(2)、无胰腺纤维化和胰腺脂肪浸润是 PF 的显著预测因子。基于存在风险因素的数量的评分将患者人群分为 4 个亚组，PF 风险从 7%（无风险因素）到 78%（3 个风险因素）不等，考虑到仅出现症状性 PF（B 级和 C 级），风险从 0%到 81%不等。
BMI 增加、胰腺脂肪浸润和胰腺纤维化的存在作为 PF 的风险因素，比单独评估胰腺残端质地更能准确客观地预测 PF。基于这 3 个因素的预测评分有助于针对预防措施进行个性化调整。
