胃癌手术后通过检测引流液中淀粉酶来诊断胰瘘：一项中期分析
The measurement of amylase in drain fluid for the detection of pancreatic fistula after gastric cancer surgery: an interim analysis.
作者信息
De Sol Angelo, Cirocchi Roberto, Di Patrizi Micol Sole, Boccolini Andrea, Barillaro Ivan, Cacurri Alban, Grassi Veronica, Corsi Alessia, Renzi Claudio, Giuliani Daniele, Coccetta Marco, Avenia Nicola
出版信息
World J Surg Oncol. 2015 Feb 19;13:65. doi: 10.1186/s12957-014-0428-y.
BACKGROUND
Pancreatic fistula is still one of the most serious and potential complications after D2-D3 distal and total gastrectomy (4% to 6%). Despite their importance, pancreatic fistulas still have not been uniformly defined. Amylase concentration of the drainage fluid after surgery for gastric cancer can be considered as a predictive factor of the presence of pancreatic fistula.
METHODS
From January 2009 to April 2013, 53 patients underwent surgery for gastric cancer. Amylase concentration in the drainage fluid was measured on the first postoperative day and if it was ≥1,000 UI, it was measured again on the third postoperative day. Pancreatic fistula occurred in four cases (7.5%). Pancreatic fistulas were classified using the International Study Group on Pancreatic Fistula (ISGPF) criteria into different grades of severity. Two fistulas were Grade A, one was Grade B, and one was Grade C.
RESULTS
Management of drainage tubes is still crucial after gastrectomy, not only for the likelihood of anastomotic leaks but also the eventual diagnosis and management of pancreatic fistula. High amylase drainage content and then the presence of the pancreatic fistula may be due to several causes: the operation itself when it includes splenectomy or pancreatic tail-splenectomy, the extended lymphadenectomy but even the 'gently and softly' pancreatic manipulation, according literature, may be a risk factor.
CONCLUSIONS
The authors assessed amylase concentration in the drainage fluid collected from the left subphrenic cavity on POD1 and POD3 in 53 patients who had undergone curative gastrectomy for cancer and concluded that amylase drainage content >3 times the serum amylase was a useful predictive risk factor for pancreatic fistula. Our work is an interim analysis and the aim of this study is to increase the accrual of the number of patients to have a significant number. For this reason, a protocol for a multicenter trial will be designed to verify whether the systematic measurement of amylase in drain fluid is better than abdominal ultrasound for the detection of pancreatic fistula after gastric cancer surgery.
背景
胰瘘仍是D2 - D3远端及全胃切除术后最严重且潜在的并发症之一（发生率为4%至6%）。尽管其很重要，但胰瘘的定义仍未统一。胃癌手术后引流液中的淀粉酶浓度可被视为胰瘘存在与否的预测因素。
方法
2009年1月至2013年4月，53例患者接受了胃癌手术。术后第一天测量引流液中的淀粉酶浓度，若≥1000 UI，则在术后第三天再次测量。4例（7.5%）发生了胰瘘。根据国际胰瘘研究组（ISGPF）标准将胰瘘分为不同严重程度等级。2例为A级瘘，1例为B级瘘，1例为C级瘘。
结果
胃切除术后引流管的管理仍然至关重要，这不仅关乎吻合口漏的可能性，还涉及胰瘘的最终诊断与处理。高淀粉酶引流液含量以及随后胰瘘的出现可能有多种原因：手术本身若包括脾切除术或胰尾 - 脾切除术、扩大的淋巴结清扫术，但根据文献，即使是“轻柔”的胰腺操作也可能是一个危险因素。
结论
作者评估了53例接受根治性胃癌切除术患者术后第1天（POD1）和第3天（POD3）从左膈下腔收集的引流液中的淀粉酶浓度，得出淀粉酶引流液含量>血清淀粉酶3倍是胰瘘的一个有用预测危险因素。我们的工作是一项中期分析，本研究的目的是增加患者数量以达到显著数量。因此，将设计一项多中心试验方案，以验证胃癌手术后引流液中淀粉酶的系统测量对于检测胰瘘是否优于腹部超声。
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