序贯引流淀粉酶以指导胰腺切除术后引流管的拔除。
Sequential drain amylase to guide drain removal following pancreatectomy.
作者信息
Villafane-Ferriol Nicole, Van Buren George, Mendez-Reyes Jose E, McElhany Amy L, Massarweh Nader N, Silberfein Eric J, Hsu Cary, Tran Cao Hop S, Schmidt Carl, Zyromski Nicholas J, Dillhoff Mary E, Roch Alexandra, Oliva Evelyn, Smith Alexander C, Zhang Qianzi, Fisher William E
机构信息
Baylor College of Medicine, Michael E. DeBakey Department of Surgery, One Baylor Plaza Suite 404D, Houston, TX 77030, USA.
The Ohio State University, Department of Surgery, M256 Starling Loving Hall, 320W 10th Avenue, Columbus, OH 43210, USA.
出版信息
HPB (Oxford). 2018 Jun;20(6):514-520. doi: 10.1016/j.hpb.2017.11.008. Epub 2018 Feb 23.
BACKGROUND
Although used as criterion for early drain removal, postoperative day (POD) 1 drain fluid amylase (DFA) ≤ 5000 U/L has low negative predictive value for clinically relevant postoperative pancreatic fistula (CR-POPF). It was hypothesized that POD3 DFA ≤ 350 could provide further information to guide early drain removal.
METHODS
Data from a pancreas surgery consortium database for pancreatoduodenectomy and distal pancreatectomy patients were analyzed retrospectively. Those patients without drains or POD 1 and 3 DFA data were excluded. Patients with POD1 DFA ≤ 5000 were divided into groups based on POD3 DFA: Group A (≤350) and Group B (>350). Operative characteristics and 60-day outcomes were compared using chi-square test.
RESULTS
Among 687 patients in the database, all data were available for 380. Fifty-five (14.5%) had a POD1 DFA > 5000. Among 325 with POD1 DFA ≤ 5000, 254 (78.2%) were in Group A and 71 (21.8%) in Group B. Complications (35 (49.3%) vs 87 (34.4%); p = 0.021) and CR-POPF (13 (18.3%) vs 10 (3.9%); p < 0.001) were more frequent in Group B.
CONCLUSIONS
In patients with POD1 DFA ≤ 5000, POD3 DFA ≤ 350 may be a practical test to guide safe early drain removal. Further prospective testing may be useful.
背景
尽管术后第1天引流液淀粉酶（DFA）≤5000 U/L被用作早期拔管的标准，但对于临床相关的术后胰瘘（CR-POPF），其阴性预测价值较低。据推测，术后第3天DFA≤350可提供更多信息以指导早期拔管。
方法
对胰腺手术联盟数据库中胰十二指肠切除术和胰体尾切除术患者的数据进行回顾性分析。排除没有引流管或术后第1天和第3天DFA数据的患者。术后第1天DFA≤5000的患者根据术后第3天DFA分为两组：A组（≤350）和B组（>350）。采用卡方检验比较手术特征和60天结局。
结果
数据库中的687例患者中，380例患者的所有数据均可用。55例（14.5%）术后第1天DFA>5000。在325例术后第1天DFA≤5000的患者中，254例（78.2%）属于A组，71例（21.8%）属于B组。B组的并发症（35例（49.3%）对87例（34.4%）；p = 0.021）和CR-POPF（13例（18.3%）对10例（3.9%）；p < 0.001）更为常见。
结论
在术后第1天DFA≤5000的患者中，术后第3天DFA≤350可能是指导安全早期拔管的一项实用检测。进一步的前瞻性试验可能会有所帮助。
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