Umezaki Naoki, Hashimoto Daisuke, Nakagawa Shigeki, Kitano Yuki, Yamamura Kensuke, Chikamoto Akira, Matsumura Fujio, Baba Hideo
Department of Gastroenterological Surgery, Kumamoto University Graduate School of Medical Sciences, 1-1-1 Honjo, Kumamoto, 860-8556, Japan.
Department of Gastroenterological Surgery, Omuta Tenryo Hospital, 1-100 Tenryo, Omuta, 836-8566, Japan.
Surg Today. 2018 Aug;48(8):790-795. doi: 10.1007/s00595-018-1656-5. Epub 2018 Mar 24.
To establish if the number of pancreatic acinar cells at the pancreatic cut end is a predictor of postoperative pancreatic fistula (POPF).
The number of acinar cells was assessed histologically in 121 consecutive patients who underwent pancreaticoduodenectomy (PD) between April, 2012 and July, 2016.
POPF developed in 23 of the 121 patients. Univariate analysis revealed that male sex, long operating time, high volume of blood loss, soft remnant pancreas, large pancreatic duct, and the number of pancreatic acinar cells were significantly associated with POPF. Multivariate analysis revealed that male sex (p = 0.022) and the number of pancreatic acinar cells (p < 0.0001) were independently associated with POPF. In the receiver operating characteristic (ROC) curve analysis, the area under curve was 0.83895 when the cut off value of the number of pancreatic acinar cells to predict POPF was 890. Sensitivity and specificity of the number of pancreatic acinar cells were 82.6 and 77.6%, respectively.
A large number of pancreatic acinar cells at the cut end of the stump is predictive of POPF after PD. Although POPF is associated with multiple factors and the number of acinar cells is only one of these, our study is the first to confirm this common intuition of surgeons, which has not been assessed definitively before.
确定胰腺断端腺泡细胞数量是否为术后胰瘘（POPF）的预测指标。
对2012年4月至2016年7月期间连续接受胰十二指肠切除术（PD）的121例患者进行组织学评估腺泡细胞数量。
121例患者中有23例发生POPF。单因素分析显示，男性、手术时间长、失血量多、残余胰腺质地软、胰管粗大以及胰腺腺泡细胞数量与POPF显著相关。多因素分析显示，男性（p = 0.022）和胰腺腺泡细胞数量（p < 0.0001）与POPF独立相关。在受试者工作特征（ROC）曲线分析中，当预测POPF的胰腺腺泡细胞数量截断值为890时，曲线下面积为0.83895。胰腺腺泡细胞数量的敏感性和特异性分别为82.6%和77.6%。
残端断端大量胰腺腺泡细胞可预测PD术后的POPF。尽管POPF与多种因素相关，且腺泡细胞数量只是其中之一，但我们的研究首次证实了外科医生的这一普遍直觉，此前尚未进行过明确评估。
