Department of Hepatobiliary and Pancreatic Surgery, Graduate School of Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan.
Department of Molecular Oncology, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan.
World J Surg. 2019 Aug;43(8):2069-2076. doi: 10.1007/s00268-019-05009-8.
Pancreatic fistula after distal pancreatectomy (DP) remains an unsolved problem, and postoperative CT imaging often demonstrates fluid collection (FC) around the pancreatic remnant. This study sought to clarify the clinical implications of FC.
This study enrolled 146 patients who underwent DP. FC was defined as a cyst-like lesion ≥ 10 mm in diameter on CT imaging at postoperative day (POD) 7. FC size, irregularity of FC margin, and air bubbles in FC were investigated. In addition, clinical data were retrospectively collected, and useful predictive factors for postoperative pancreatic fistula (POPF) were analyzed.
Clinically relevant POPF was observed in 26 patients (17.8%), and FC was detected in 136 patients (94.4%). Multivariate analysis identified FC size and drain amylase levels on POD3 as significant risk factors for POPF. Cutoff values were determined by ROC analyses, and the levels of the FC size and drain amylase on POD3 were determined as 41 mm and 1026 IU/L, respectively. The sensitivity and specificity of FC diameters > 41 mm were 76.9% and 75.0%, respectively, while those of drain amylase levels > 1026 IU on POD3 were 73.1% and 75.8%, respectively.
While treating some FCs after DP was necessary for the management of POPF, others did not require any intervention since most of them spontaneously disappeared. FC size and drain amylase levels on POD3 were found to be significantly associated with POPF and could potentially help to determine appropriate treatment.
远端胰腺切除术（DP）后胰瘘仍然是一个未解决的问题，术后 CT 影像学常显示胰腺残端周围有液体聚集（FC）。本研究旨在阐明 FC 的临床意义。
本研究纳入了 146 例行 DP 的患者。FC 定义为术后第 7 天 CT 成像上直径≥10mm 的囊性病变。研究人员对 FC 的大小、FC 边缘不规则性和 FC 内气泡进行了研究。此外，还回顾性收集了临床资料，并对术后胰腺瘘（POPF）的预测因素进行了分析。
26 例患者（17.8%）出现临床相关 POPF，136 例患者（94.4%）检测到 FC。多变量分析确定 FC 大小和术后第 3 天引流淀粉酶水平是 POPF 的显著危险因素。通过 ROC 分析确定了截断值，FC 大小和术后第 3 天引流淀粉酶的截断值分别为 41mm 和 1026IU/L。FC 直径>41mm 的敏感性和特异性分别为 76.9%和 75.0%，而术后第 3 天引流淀粉酶水平>1026IU/L 的敏感性和特异性分别为 73.1%和 75.8%。
虽然 DP 后一些 FC 的处理对于 POPF 的管理是必要的，但其他 FC 不需要任何干预，因为它们中的大多数会自行消失。FC 大小和术后第 3 天引流淀粉酶水平与 POPF 显著相关，可能有助于确定合适的治疗方案。
