Uchida Yuichiro, Masui Toshihiko, Sato Asahi, Nagai Kazuyuki, Anazawa Takayuki, Takaori Kyoichi, Uemoto Shinji
Division of Hepatobiliary Pancreatic Surgery and Transplantation, Department of Surgery, Kyoto University, Syogoinkawaharacho 54, Sakyo-ku, Kyoto, Japan.
Langenbecks Arch Surg. 2018 May;403(3):349-357. doi: 10.1007/s00423-018-1668-z. Epub 2018 Mar 27.
Peripancreatic collections occur frequently after distal pancreatectomy. However, the sequelae of peripancreatic collections vary from case to case, and their clinical impact is uncertain. In this study, the correlations between CT findings of peripancreatic collections and complications after distal pancreatectomy were investigated.
Ninety-six consecutive patients who had undergone distal pancreatectomy between 2010 and 2015 were retrospectively investigated. The extent and heterogeneity of peripancreatic collections and background clinicopathological characteristics were analyzed. The extent of peripancreatic collections was calculated based on three-dimensional computed tomography images, and the degree of heterogeneity of peripancreatic collections was assessed based on the standard deviation of their density on computed tomography.
Of 85 patients who underwent postoperative computed tomography imaging, a peripancreatic collection was detected in 77 (91%). Patients with either a large extent or a high degree of heterogeneity of peripancreatic collection had a significantly higher rate of clinically relevant pancreatic fistula than those without (odds ratio 5.95, 95% confidence interval 2.12-19.72, p = 0.001; odds ratio 8.0, 95% confidence interval 2.87-24.19, p = 0.0001, respectively).
A large and heterogeneous peripancreatic collection was significantly associated with postoperative complications, especially clinically relevant postoperative pancreatic fistula. A small and homogenous peripancreatic collection could be safely observed.
胰周积液在胰体尾切除术后很常见。然而，胰周积液的后遗症因病例而异，其临床影响尚不确定。本研究探讨了胰周积液的CT表现与胰体尾切除术后并发症之间的相关性。
回顾性研究了2010年至2015年间连续接受胰体尾切除术的96例患者。分析了胰周积液的范围和异质性以及背景临床病理特征。基于三维计算机断层扫描图像计算胰周积液的范围，并基于计算机断层扫描上其密度的标准差评估胰周积液的异质性程度。
在85例接受术后计算机断层扫描成像的患者中，77例（91%）检测到胰周积液。胰周积液范围大或异质性程度高的患者发生临床相关胰瘘的比率显著高于无上述情况的患者（优势比分别为5.95，95%置信区间2.12 - 19.72，p = 0.001；优势比8.0，95%置信区间2.87 - 24.19，p = 0.0001）。
胰周积液范围大且异质性高与术后并发症显著相关，尤其是临床相关的术后胰瘘。小而均匀的胰周积液可安全观察。
