Chang Ye Rim, Kang Jae Seung, Jang Jin-Young, Jung Woo Hyun, Kang Mee Joo, Lee Kyung Bun, Kim Sun-Whe
Department of Surgery, Seoul National University College of Medicine, Seoul National University Hospital, 28, Yeongeondong, Jongno-gu, Seoul, 110-744, Korea.
Department of Surgery, Dankook University College of Medicine, Cheonan, Korea.
World J Surg. 2017 Jun;41(6):1610-1617. doi: 10.1007/s00268-017-3872-3.
Postoperative pancreatic fistula (POPF) is one of the most common and clinically relevant complications after distal pancreatectomy (DP), occurring in 5-40% of patients. Determining risk factors for this complication may aid in its prevention. This study sought to predict the development of POPF after DP preoperatively and objectively based on radiologic findings.
This study included 60 patients who underwent DP using a stapler for pancreatic division between June 2011 and January 2013. Fatty infiltration, apparent diffusion coefficients (ADC) on preoperative MRI, pathologic fat, and fibrosis were measured. Pancreatic thickness and cross-sectional area of the pancreas stump on CT scan were also measured.
Mean patient age was 60.5 years, 26 patients (46.3%) had pancreatic cancer and 20 (33.3%) underwent laparoscopic surgery. Clinically relevant POPF was observed in 12 patients (20.0%). Linear regression analysis showed a significant correlation between fat quantification on MRI and pathologic fat (pathologic fat = 1.978 × MR fat -6.393, p < 0.001, R = 0.777). Univariate analysis showed that ≤8% fat on MRI (p = 0.040), ≤5% pathologic fat (p = 0.002), ADC ≤ 1.3 × 10 mm/s (p = 0.020), thicker pancreas (p = 0.007), and wider cross-sectional area of the pancreas (p = 0.013) were significantly associated with clinically relevant POPF after DP. Multivariate analysis revealed that pancreas thickness >17.6 mm [odds ratio (OR) 6.532, p = 0.064] and cross-sectional area >377 mm (OR 12.676, p = 0.052) were marginally related to clinically relevant POPF.
Pancreatic thickness and cross-sectional area of the transected surface of the pancreas are marginally significant risk factors for POPF development after DP. Measuring pancreatic thickness and cross-sectional area can be a promising tool for the preoperative prediction of POPF.
术后胰瘘（POPF）是胰体尾切除术（DP）后最常见且具有临床相关性的并发症之一，发生率为5% - 40%。确定该并发症的危险因素可能有助于预防。本研究旨在基于影像学表现术前客观预测DP后POPF的发生。
本研究纳入了2011年6月至2013年1月间60例行DP并使用吻合器进行胰腺离断的患者。测量了脂肪浸润、术前MRI上的表观扩散系数（ADC）、病理脂肪和纤维化情况。还测量了CT扫描时胰腺残端的厚度和横截面积。
患者平均年龄为60.5岁，26例（46.3%）患有胰腺癌，20例（33.3%）接受了腹腔镜手术。12例患者（20.0%）出现了具有临床相关性的POPF。线性回归分析显示MRI上的脂肪定量与病理脂肪之间存在显著相关性（病理脂肪 = 1.978×MR脂肪 - 6.393，p < 0.001，R = 0.777）。单因素分析显示，MRI上脂肪≤8%（p = 0.040）、病理脂肪≤5%（p = 0.002）、ADC≤1.3×10⁻³mm²/s（p = 0.020）、胰腺更厚（p = 0.007）以及胰腺横截面积更大（p = 0.013）与DP后具有临床相关性的POPF显著相关。多因素分析显示，胰腺厚度>17.6mm [比值比（OR）6.532，p = 0.064]和横截面积>377mm²（OR 12.676，p = 0.052）与具有临床相关性的POPF存在边缘相关性。
胰腺残端的厚度和横截面积是DP后POPF发生的边缘性显著危险因素。测量胰腺厚度和横截面积可能是术前预测POPF的一种有前景的工具。
