更新后的国际术后胰瘘定义对胰体尾切除术临床影响的研究
Clinical impact of the updated international postoperative pancreatic fistula definition in distal pancreatectomy.
机构信息
Department of Surgery, Cancer Center Amsterdam, Amsterdam University Medical Center, Amsterdam, The Netherlands.
Department of Surgery, Verona University Hospital, Verona, Italy.
出版信息
HPB (Oxford). 2018 Nov;20(11):1044-1050. doi: 10.1016/j.hpb.2018.05.003. Epub 2018 Jun 23.
BACKGROUND
Postoperative pancreatic fistula (POPF) remains the most common complication after distal pancreatectomy. The International Study Group on Pancreatic Surgery definition of POPF is used worldwide. Recently, an update of the definition was published. The aim of this study was to determine the clinical impact of the update.
METHODS
An international retrospective validation study, including patients who underwent DP (2005 -2016) in 5 centers was performed. Distribution of complications amongst POPF grades were compared for the old and updated definition.
RESULTS
In total, 1089 patients were included. The incidence of POPF decreased with the updated definition from 47% to 24% (P < 0.01), largely because a downgrade of grade A and grade B into biochemical leak. Comparable morbidity was seen in the old and updated 'no POPF group' (Clavien -Dindo 3 5% vs. 6% P = 0.320 and hospital stay (7 vs. 7 days P = 0.301). The change in definition of POPF grade B resulted in more Clavien -Dindo 3 (38% vs. 51%) P < 0.01) and longer hospital stay (9 [9 -13] vs. 9 days [7 -15] P < 0.01) in the updated `grade B group'.
CONCLUSION
Applying the updated POPF definition showed improved discrimination between grades and should therefore be used to report POPF after DP.
背景
胰十二指肠切除术后胰瘘（POPF）仍然是最常见的术后并发症。国际胰腺外科研究组（ISGPS）定义的 POPF 在全球范围内得到应用。最近，该定义进行了更新。本研究旨在确定更新定义的临床影响。
方法
对 5 家中心 2005 年至 2016 年间接受 DP 的患者进行了国际回顾性验证研究。对新旧定义的 POPF 分级并发症分布进行了比较。
结果
共纳入 1089 例患者。随着新定义的应用，POPF 的发生率从 47%降至 24%（P < 0.01），这主要是因为 A 级和 B 级的降级为生化漏。旧定义和新定义的“无 POPF 组”的发病率相似（Clavien-Dindo 3 级 5%比 6%，P = 0.320 和住院时间（7 天比 7 天，P = 0.301）。POPF 分级 B 定义的改变导致了更多的 Clavien-Dindo 3 级（38%比 51%，P < 0.01）和更长的住院时间（9 天[9-13]比 9 天[7-15]，P < 0.01）。
结论
应用新的 POPF 定义可改善分级之间的区分度，因此应在 DP 术后报告 POPF 时使用。
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