Surgical and Gastroenterological Department, University of Verona, Verona, Italy.
Langenbecks Arch Surg. 2011 Jan;396(1):91-8. doi: 10.1007/s00423-010-0719-x. Epub 2010 Nov 3.
Postoperative pancreatic fistula (POPF) has a wide range of clinical and economical implications due to the difference of the associated complications and management. The aim of this study is to verify the applicability of the International Study Group of Pancreatic Fistula (ISGPF) definition and its capability to predict hospital costs.
This is a retrospective study based on prospectively collected data of 755 patients who underwent pancreaticoduodenectomy in our institution between November 1996 and October 2006. A number of 147 patients (19.5%) have developed a POPF according to ISGPF definition.
Grade A fistula, which has no clinical impact, occurred in 19% of all cases. Grade B occurred in 70.7% and was successfully managed with conservative therapy or mini-invasive procedures. Grade C (8.8%) was associated to severe clinical complications and required invasive therapy. Pulmonary complications were statistically higher in the groups B and C rather than the group A POPFs (p < 0.005; OR 8). Patients with carcinoma of the ampullary region had a higher incidence of POPF compared to ductal cancer, with a predominance of grade A (p = 0.036). Increasing fistula grades have higher hospital costs (€11,654, €25,698, and €59,492 for grades A, B, and C, respectively; p < 0.001).
The development of a POPF does not always determine a substantial change of the postoperative management. Clinically relevant fistulas can be treated conservatively in most cases. Higher fistula severity corresponds to increased costs. The grading system proposed by the ISGPF allows a correct stratification of the complicated patients based on the real clinical and economic impact of the POPF.
由于相关并发症和处理方式的不同，术后胰瘘（POPF）具有广泛的临床和经济意义。本研究旨在验证国际胰腺瘘研究小组（ISGPF）定义的适用性及其预测住院费用的能力。
这是一项基于我院 1996 年 11 月至 2006 年 10 月期间行胰十二指肠切除术的 755 例患者前瞻性收集数据的回顾性研究。根据 ISGPF 定义，有 147 例（19.5%）患者发生了 POPF。
所有病例中，A级瘘（无临床影响）发生率为 19%。B 级瘘发生率为 70.7%，经保守治疗或微创治疗成功处理。C 级瘘（8.8%）与严重临床并发症相关，需要侵袭性治疗。B 级和 C 级瘘的肺部并发症发生率明显高于 A 级瘘（p < 0.005；OR 8）。与胆管癌相比，壶腹周围区域癌患者的 POPF 发生率更高，且以 A 级为主（p = 0.036）。瘘管分级越高，住院费用越高（A、B、C 级分别为 11654 欧元、25698 欧元和 59492 欧元；p < 0.001）。
POPF 的发生并不总是决定术后处理的实质性改变。大多数情况下，临床上相关的瘘管可以保守治疗。更严重的瘘管程度对应更高的成本。ISGPF 提出的分级系统可以根据 POPF 的实际临床和经济影响，对复杂患者进行正确的分层。
