Joliat Gaëtan-Romain, Petermann David, Demartines Nicolas, Schäfer Markus
From the Department of Visceral Surgery, University Hospital CHUV, Lausanne, Switzerland.
Pancreas. 2015 Nov;44(8):1323-8. doi: 10.1097/MPA.0000000000000399.
Pancreatic surgery remains associated with important morbidity. Efforts are most commonly concentrated on decreasing postoperative morbidity, but early detection of patients at risk could be another valuable strategy. A simple prognostic score has recently been published. This study aimed to validate this score and discuss possible clinical implications.
From 2000 to 2012, 245 patients underwent a pancreaticoduodenectomy. Complications were graded according to the Dindo-Clavien Classification. The Braga score is based on American Society of Anesthesiologists score, pancreatic texture, Wirsung duct diameter, and blood loss. An overall risk score (0-15) can be calculated for each patient. Score discriminant power was calculated using a receiver operating characteristic curve.
Major complications occurred in 31% of patients compared with 17% in Braga's data. Pancreatic texture and blood loss were independently statistically significant for increased morbidity. Areas under the curve were 0.95 and 0.99 for 4-risk categories and for individual scores, respectively.
The Braga score discriminates well between minor and major complications. Our validation suggests that it can be used as a prognostic tool for major complications after pancreaticoduodenectomy. The clinical implications, that is, whether postoperative treatment strategies should be adapted according to the patient's individual risk, remain to be elucidated.
胰腺手术仍伴随着严重的并发症。人们通常将精力集中在降低术后并发症发生率上，但早期发现高危患者可能是另一种有价值的策略。最近公布了一种简单的预后评分。本研究旨在验证该评分并探讨其可能的临床意义。
2000年至2012年，245例患者接受了胰十二指肠切除术。并发症根据Dindo-Clavien分类法进行分级。Braga评分基于美国麻醉医师协会评分、胰腺质地、胰管直径和失血量。可以为每位患者计算一个总体风险评分（0 - 15分）。使用受试者工作特征曲线计算评分的判别能力。
31%的患者发生了严重并发症，而Braga数据中的这一比例为17%。胰腺质地和失血量与并发症发生率增加独立相关，且具有统计学意义。4种风险类别和各个评分的曲线下面积分别为0.95和0.99。
Braga评分能很好地区分轻微和严重并发症。我们的验证表明，它可作为胰十二指肠切除术后严重并发症的预后工具。其临床意义，即术后治疗策略是否应根据患者的个体风险进行调整，仍有待阐明。
