Hanaki Takehiko, Uejima Chihiro, Amisaki Masataka, Yosuke Arai, Tokuyasu Naruo, Honjo Soichiro, Sakamoto Teruhisa, Saito Hiroaki, Ikeguchi Masahide, Fujiwara Yoshiyuki
Department of Surgery, Tottori Prefectural Central Hospital, 730 Ezu, Tottori, 680-0901, Japan.
Division of Surgical Oncology, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, Yonago, 683-8504, Japan.
Surg Today. 2018 Jun;48(6):598-608. doi: 10.1007/s00595-018-1626-y. Epub 2018 Jan 30.
Pancreatic fistula (PF) is the most serious complication following pancreaticoduodenectomy (PD). This study was performed to identify new clinical factors that may predict the development of PF after PD to improve perioperative management.
Seventy-five consecutive patients who underwent PD from 2012 to 2015 were evaluated. The patients' perioperative data including the computed tomography (CT) parameters were collected. The minimum, maximum, and mean CT attenuation values (HU, HU, and HU, respectively) were extracted from the pancreatic parenchyma (≥ 100 pixels), and the standard deviation of these values (HU) was determined from the slice in which the superior mesenteric and splenic veins were merged. PF was defined as grade B or C according to the International Study Group for Pancreatic Fistula criteria.
The PF occurrence rate (grade B or C) was 25.3% in 75 patients. A multivariate analysis identified a larger HU (odds ratio 3.092; 95% CI 1.018-9.394) and higher amylase concentration in drainage fluid on postoperative day 1 (odds ratio 1.0001; 95% CI 1.00001-1.00022) as significant risk factors for PF.
The HU of preoperative CT attenuation values in the pancreatic parenchyma was found to be an independent predictor for PF after PD and it might therefore positively contribute to the perioperative management of PD.
胰瘘（PF）是胰十二指肠切除术（PD）后最严重的并发症。本研究旨在确定可能预测PD后PF发生的新临床因素，以改善围手术期管理。
对2012年至2015年连续接受PD的75例患者进行评估。收集患者的围手术期数据，包括计算机断层扫描（CT）参数。从胰腺实质（≥100像素）中提取最小、最大和平均CT衰减值（分别为HU、HU和HU），并从肠系膜上静脉和脾静脉汇合处的切片中确定这些值的标准差（HU）。根据国际胰瘘研究组标准，将PF定义为B级或C级。
75例患者中PF发生率（B级或C级）为25.3%。多因素分析确定较大的HU（比值比3.092；95%可信区间1.018-9.394）和术后第1天引流液中较高的淀粉酶浓度（比值比1.0001；95%可信区间1.00001-1.00022）是PF的显著危险因素。
胰腺实质术前CT衰减值的HU被发现是PD后PF的独立预测因素，因此可能对PD的围手术期管理有积极贡献。
