Serene Tang Ee Ling, G Shelat Vishalkumar, Padmakumar Junnarkar Sameer, Terence Huey Cheong Wei, Keem Low Jee, Bei Wang, Winston Woon Wei Liang
Department of General Surgery, Tan Tock Seng Hospital, Singapore.
Ann Hepatobiliary Pancreat Surg. 2018 Nov;22(4):397-404. doi: 10.14701/ahbps.2018.22.4.397. Epub 2018 Nov 27.
BACKGROUNDS/AIMS: Traditionally, surgically placed pancreatic drains are removed, at the discretion of the operating surgeon. Moving towards enhanced recovery after surgery (ERAS), we looked for predictors for early drain removal. The purpose of this paper was to establish which postoperative days' (POD) drain amylase is most predictive against post-operative pancreatic fistula (POPF).
We conducted a retrospective study of 196 patients who underwent pancreatic resection at our institute from January 2006 to October 2013. Drain amylase levels were routinely measured. The International Study Group of Pancreatic Fistula (ISGPF) definition of POPF, and clinical severity grading were used.
5.1% (10 of 196) patients developed ISGPF Grades B and C POPF. Negative predictive value of developing significant POPF, if drain amylase values were low on PODs 1 and 3 was 98.7% (95% CI: 0.93-1.00). This translated to confidence in removing surgically placed pancreatic drains, at POD 1 and 3 when drain amylase values are low.
Patients with low drain amylase values on POD 1 and 3, are unlikely to develop POPF and may have pancreatic drains removed earlier.
背景/目的：传统上，手术放置的胰管引流管由主刀医生自行决定拔除。随着术后加速康复（ERAS）理念的推行，我们寻找早期拔除引流管的预测指标。本文旨在确定术后哪一天的引流液淀粉酶对术后胰瘘（POPF）最具预测性。
我们对2006年1月至2013年10月在我院接受胰腺切除术的196例患者进行了回顾性研究。常规测量引流液淀粉酶水平。采用国际胰瘘研究组（ISGPF）对POPF的定义及临床严重程度分级。
5.1%（196例中的10例）患者发生ISGPF B级和C级POPF。如果术后第1天和第3天引流液淀粉酶值较低，则发生严重POPF的阴性预测值为98.7%（95%CI：0.93 - 1.00）。这意味着当术后第1天和第3天引流液淀粉酶值较低时，可以放心拔除手术放置的胰管引流管。
术后第1天和第3天引流液淀粉酶值低的患者不太可能发生POPF，可能可以更早拔除胰管引流管。
