Okano Keiichi, Kakinoki Keitaro, Suto Hironobu, Oshima Minoru, Kashiwagi Hirotaka, Yamamoto Naoki, Akamoto Shintaro, Fujiwara Masao, Takama Takehiro, Usuki Hisashi, Hagiike Masanobu, Suzuki Yasuyuki
Department of Gastroenterological Surgery, Faculty of Medicine, Kagawa University, 1750-1, Ikenobe, Miki-cho, Kita-gun, Kagawa, 761-0793, Japan.
J Hepatobiliary Pancreat Sci. 2011 Nov;18(6):815-20. doi: 10.1007/s00534-011-0393-6.
BACKGROUND/PURPOSE: A consistent predictor for pancreatic fistula (PF) development in the early period after pancreatic resection is still lacking.
A total of 54 consecutive patients undergoing pancreatic resection were enrolled between June 2007 and April 2010. Pancreaticoduodenectomy (PD) and distal pancreatectomy (DP) were performed in 38 and 16 patients, respectively. For the purpose of finding an early predictor for PF development, we investigated drain amylase levels (d-Amy, IU/mL), drain output volume (d-Vol, mL/day) and drain amylase output (Amy-V, IU/day) on postoperative days (POD) 1 and 3. Amy-V was calculated as the product of d-Amy and d-Vol, and was expressed as the sum of values obtained from all drains. In addition, the ratio of d-Amy or Amy-V on POD3 to that on POD1 was calculated as the persisting ratio in each patient.
The overall incidence of clinical PF (International Study Group on Pancreatic Fistula Grade B and C) was 16.7%, occurring in 13.1% after PD and 25% after DP. All PF occurred in cases with a remnant pancreas of soft texture. There was no significant difference in d-Amy, d-Vol, or Amy-V on POD1 and POD3 between patients with and without clinical PF. The persisting ratio of Amy-V was significantly lower in patients without clinical PF compared to those with clinical PF (p = 0.029). Furthermore, the persisting ratio of Amy-V was significantly lower in patients with Grade A PF compared to those with Grade B PF (p = 0.03).
The persisting ratio of drain amylase output is a new significant predictive factor for clinical PF development.
背景/目的：目前仍缺乏胰腺切除术后早期胰瘘（PF）发生的一致性预测指标。
2007年6月至2010年4月期间，共纳入54例连续接受胰腺切除术的患者。其中38例患者接受了胰十二指肠切除术（PD），16例患者接受了远端胰腺切除术（DP）。为了寻找PF发生的早期预测指标，我们在术后第1天和第3天对引流液淀粉酶水平（d-Amy，IU/mL）、引流量（d-Vol，mL/天）和引流液淀粉酶排出量（Amy-V，IU/天）进行了研究。Amy-V通过d-Amy与d-Vol的乘积计算得出，并表示为所有引流管获得值的总和。此外，将术后第3天的d-Amy或Amy-V与术后第1天的比值计算为每位患者的持续比值。
临床PF（国际胰瘘研究组B级和C级）的总体发生率为16.7%，PD术后发生率为13.1%，DP术后发生率为25%。所有PF均发生在残留胰腺质地柔软的病例中。有临床PF和无临床PF的患者在术后第1天和第3天的d-Amy、d-Vol或Amy-V方面无显著差异。无临床PF的患者Amy-V的持续比值显著低于有临床PF的患者（p = 0.029）。此外，A级PF患者的Amy-V持续比值显著低于B级PF患者（p = 0.03）。
引流液淀粉酶排出量的持续比值是临床PF发生的一个新的重要预测因素。
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