Nahm Christopher B, de Reuver Philip R, Hugh Thomas J, Pearson Andrew, Gill Anthony J, Samra Jaswinder S, Mittal Anubhav
Upper Gastrointestinal Surgical Unit, Department of Gastrointestinal Surgery, Royal North Shore Hospital, Reserve Road, St. Leonards, 2065, NSW, Australia.
North Shore Private Hospital, Reserve Road, St. Leonards, 2065, NSW, Australia.
J Gastrointest Surg. 2017 Jun;21(6):1031-1037. doi: 10.1007/s11605-017-3395-0. Epub 2017 Mar 20.
Post-operative pancreatic fistula (POPF) is a potentially severe complication following distal pancreatectomy. The aim of this study was to assess the predictive value of intra-operative amylase concentration (IOAC) in peri-pancreatic fluid after distal pancreatectomy for the diagnosis of POPF. Consecutive patients who underwent a distal pancreatectomy between November 2014 and September 2016 were included in the analysis. IOAC was measured, followed by drain fluid analysis for amylase on post-operative days (PODs) 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 distal pancreatectomy in 26 patients. The IOAC correlated significantly with (i) PODs 1, 3, and 5 drain amylase (p < 0.01); (ii) the development of POPF (p < 0.01); and (iii) the Clavien-Dindo grade of surgical complications (p = 0.02). Eighty-three percent of patients with an IOAC > 1000 experienced a post-operative complication (OR 18.3, 95% CI 2.51-103, p < 0.01). ROC curve analysis confirmed the predictive relationship of IOAC and POPF as an excellent test with an area under the curve of 0.92 (95% CI 0.81-0.99, p < 0.01). Measurement of IOAC allows early and accurate categorization of patients at risk for POPF in distal pancreatectomy.
术后胰瘘（POPF）是胰体尾切除术后一种潜在的严重并发症。本研究旨在评估胰体尾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。分析纳入了2014年11月至2016年9月期间连续接受胰体尾切除术的患者。测量IOAC，随后在术后第1、3和5天对引流液进行淀粉酶分析。采用受试者工作特征（ROC）分析来评估IOAC作为POPF预测指标的判别能力。对26例患者进行了胰体尾切除术后IOAC测量。IOAC与以下各项显著相关：（i）术后第1、3和5天的引流淀粉酶（p<0.01）；（ii）POPF的发生（p<0.01）；以及（iii）手术并发症的Clavien-Dindo分级（p = 0.02）。IOAC>1000的患者中有83%发生了术后并发症（比值比18.3，95%置信区间2.51-103，p<0.01）。ROC曲线分析证实了IOAC与POPF之间的预测关系，其曲线下面积为0.92（95%置信区间0.81-0.99，p<0.01），是一项出色的检测指标。测量IOAC能够对胰体尾切除术后有POPF风险的患者进行早期、准确的分类。
