de Reuver Philip R, Gundara Justin, Hugh Thomas J, Samra Jaswinder S, Mittal Anubhav
Department of Gastrointestinal Surgery, Royal North Shore Hospital and North Shore Private Hospital, University of Sydney, New South Wales, Australia.
Department of Gastrointestinal Surgery, Royal North Shore Hospital and North Shore Private Hospital, University of Sydney, New South Wales, Australia; Macquarie University Hospital, Macquarie University, New South Wales, Australia.
HPB (Oxford). 2016 Jul;18(7):608-14. doi: 10.1016/j.hpb.2016.05.007. Epub 2016 Jun 16.
Post-operative pancreatic fistula (POPF) is a common and potentially life-threatening complication following pancreaticoduodectomy. The aim of this study was to assess the predictive value of intra-operative amylase concentration (IOAC) in peri-pancreatic fluid after resection for the diagnosis of POPF.
Consecutive patients who underwent a pancreaticoduodectomy between September 2014 and October 2015 were included in the analysis. IOAC was measured intraoperatively followed by drain fluid analysis for amylase on post-operative days (POD) 1, 3 and 5. Receiver operator characteristic (ROC) analysis was performed to evaluate the discriminative capacity of IOAC as a predictor of POPF.
IOAC was measured after pancreaticoduodectomy in 62 patients. The IOAC correlated significantly with i) POD 1 and 3 drain amylase (p < 0.01), ii) the development of POPF (p < 0.01), iii) the development of clinically relevant fistula (Type B, C) (p < 0.01), iv) delayed gastric emptying (p < 0.01), and v) grade of complication as per the Clavien-Dindo definition (p = 0.02). ROC curve analysis confirmed the predictive relationship of IOAC and POPF as a good test with an area under the curve of 0.93, 95% CI 0.87-0.99, p < 0.01. In patients with IOAC of 200 U/L or higher the POPF rate was 80% (OR = 50.1, p < 0.0001).
Measurement of IOAC allows early and accurate categorization of patients at risk for POPF.
术后胰瘘（POPF）是胰十二指肠切除术后常见且可能危及生命的并发症。本研究的目的是评估切除术后胰周液体中术中淀粉酶浓度（IOAC）对POPF诊断的预测价值。
纳入2014年9月至2015年10月期间连续接受胰十二指肠切除术的患者进行分析。术中测量IOAC，术后第1、3和5天对引流液进行淀粉酶分析。进行受试者操作特征（ROC）分析以评估IOAC作为POPF预测指标的鉴别能力。
62例患者在胰十二指肠切除术后测量了IOAC。IOAC与以下各项显著相关：i）术后第1天和第3天引流液淀粉酶（p < 0.01），ii）POPF的发生（p < 0.01），iii）临床相关瘘（B型、C型）的发生（p < 0.01），iv）胃排空延迟（p < 0.01），以及v）根据Clavien-Dindo定义的并发症等级（p = 0.02）。ROC曲线分析证实了IOAC与POPF之间的预测关系，作为一项良好的检测指标，曲线下面积为0.93，95% CI为0.87 - 0.99，p < 0.01。IOAC为200 U/L或更高的患者中，POPF发生率为80%（OR = 50.1，p < 0.0001）。
测量IOAC可对有POPF风险的患者进行早期准确分类。
