Halle-Smith James M, Vinuela Eduardo, Brown Rachel M, Hodson James, Zia Zergham, Bramhall Simon R, Marudanayagam Ravi, Sutcliffe Robert P, Mirza Darius F, Muiesan Paolo, Isaac John, Roberts Keith J
Pancreatic Surgery Unit, Queen Elizabeth Hospital Birmingham, UK.
Pancreatic Surgery Unit, Queen Elizabeth Hospital Birmingham, UK.
HPB (Oxford). 2017 Aug;19(8):727-734. doi: 10.1016/j.hpb.2017.04.013. Epub 2017 May 15.
Evidence associates various biometric and histological variables such as steatosis and absence of fibrosis as risk factors for post-operative pancreatic fistula (POPF) after pancreatoduodenectomy (PD). Following distal pancreatectomy (DP), the association between these factors and POPF is less clear. This study of patients, drawn from the same background population, undergoing PD or DP at a single centre is a comparative study of the risk factors for POPF after these two operations.
Associations between POPF and patient characteristics, pre-operative blood tests, data from pre-operative computed tomography (CT) imaging, assessment of histological steatosis and fibrosis were explored.
26/107 (24%) and 26/90 (29%) patients developed POPF after PD and DP respectively. Absence of fibrosis was associated with POPF (p < 0.001) after PD and its presence correlated with pancreatic duct width (p < 0.001). Steatosis was not associated with POPF (p = 0.910). Multivariable analysis showed pancreatic duct width (p = 0.016) and fibrosis (p = 0.025) to be independent predictors of POPF after PD. The only variable associated with POPF after DP was underlying pathology (p = 0.005).
Pancreatic duct width is the most important variable related to POPF after PD and is correlated with fibrosis. Steatosis was not related to POPF. In contrast, after DP POPF appears to be related to the underlying disease.
有证据表明，各种生物特征和组织学变量，如脂肪变性和无纤维化，是胰十二指肠切除术（PD）后发生术后胰瘘（POPF）的危险因素。在远端胰腺切除术（DP）后，这些因素与POPF之间的关联尚不清楚。本研究对来自同一背景人群、在单一中心接受PD或DP的患者进行了这两种手术术后POPF危险因素的比较研究。
探讨了POPF与患者特征、术前血液检查、术前计算机断层扫描（CT）成像数据、组织学脂肪变性和纤维化评估之间的关联。
PD和DP术后分别有26/107（24%）和26/90（29%）的患者发生POPF。无纤维化与PD术后的POPF相关（p < 0.001），而纤维化的存在与胰管宽度相关（p < 0.001）。脂肪变性与POPF无关（p = 0.910）。多变量分析显示，胰管宽度（p = 0.016）和纤维化（p = 0.025）是PD术后POPF的独立预测因素。DP术后与POPF相关的唯一变量是基础病理（p = 0.005）。
胰管宽度是与PD术后POPF相关的最重要变量，且与纤维化相关。脂肪变性与POPF无关。相比之下，DP术后POPF似乎与基础疾病有关。
