Department of Surgery, St. Josef Hospital, Bochum, Germany.
Pancreatology. 2011;11(5):516-24. doi: 10.1159/000332587. Epub 2011 Nov 3.
BACKGROUND/AIMS: Postoperative pancreatic fistula (POPF) is a major complication after resective pancreatic surgery. This study aimed to identify histomorphological features of the pancreatic remnant as independent determinants for the development of POPF.
Twenty-five patients, 3.6% of 696 resections over a period of 5 years, who developed POPF were matched for age, gender, diagnosis, comorbidities, surgeon and procedure with 25 controls without POPF. Pancreatic duct size and index, fibrosis grade, fat content, edema, and signs of chronic and acute inflammation were measured in frozen sections of the resection margin and were then compared.
The POPF rate was 12.2 and 2.6% after distal pancreatectomy and pancreatoduodenectomy, respectively. The POPF group was characterized by a longer ICU and total postoperative stay, higher rate of reoperations and complications. Their pancreata were softer at palpation (88 vs. 56%). Their pancreatic duct was smaller (2.5 vs. 3.2 mm) and their pancreatic fat content higher (16 vs. 8%). High inter- and intralobular fat content, small duct size, low interlobular fibrosis grade and lack of signs of chronic pancreatitis were predictors of POPF development. A score including these parameters identified high-risk patients with a sensitivity of 92% and a specificity of 84%.
Histomorphological features of the pancreatic remnant play an independent role as risk factors for the development of POPF. A simple histological score based on the frozen sections may already intraoperatively predict the risk of POPF development.
背景/目的：手术后胰瘘（POPF）是胰腺切除术的主要并发症。本研究旨在确定胰腺残端的组织形态学特征作为发生 POPF 的独立决定因素。
在 5 年期间的 696 例切除术患者中，有 25 例（3.6%）发生了 POPF，与 25 例无 POPF 的对照组患者相匹配，这些患者的年龄、性别、诊断、合并症、外科医生和手术方式均匹配。在切除边缘的冷冻切片中测量胰管大小和指数、纤维化程度、脂肪含量、水肿以及慢性和急性炎症的迹象，并进行比较。
胰体尾切除术和胰十二指肠切除术的 POPF 发生率分别为 12.2%和 2.6%。POPF 组的 ICU 和总术后住院时间更长，再手术和并发症的发生率更高。他们的胰腺触诊时更柔软（88 比 56%）。他们的胰管更小（2.5 比 3.2 毫米），胰腺脂肪含量更高（16 比 8%）。高的小叶间和小叶内脂肪含量、小的胰管大小、低的小叶间纤维化程度和缺乏慢性胰腺炎的迹象是发生 POPF 的预测因素。包括这些参数的评分可以识别出高危患者，其敏感性为 92%，特异性为 84%。
胰腺残端的组织形态学特征作为发生 POPF 的独立危险因素起作用。基于冷冻切片的简单组织学评分可能已经可以在术中预测 POPF 发展的风险。
