Ji W C, Liu H
Department of Hepatobiliary Surgery and Organ Transplantation, the First Hospital of China Medical University, Shenyang 110001, China.
Zhonghua Wai Ke Za Zhi. 2019 Sep 1;57(9):654-659. doi: 10.3760/cma.j.issn.0529-5815.2019.09.003.
To analyze the risk factors for biochemical leak progressing to grade B pancreatic fistula after pancreaticoduodenectomy(PD) early. Retrospective analysis was conducted in the whole clinical data of 190 patients who had incurred biochemical leak from November 2014 to April 2017 at the First Hospital of China Medical University.There were 112 males and 78 females, aging of (73±6) years(range:22 to 77 years).And all the potential factors for progressing from biochemical leak to grade B were analyzed with univariate and logistic regression multivariate model. These statistically significant preoperative indicators which enabled the plotting of the receiver operation characteristic(ROC) curves were selected for plotting the ROC curves, calculating the area under the curve(AUC) and evaluating the forecast values. With pertinence to indicators with the forecast values above the medium level, the maximum predictive performance of the critical value was determined by using the different cut-off values to calculate the Youden index and other indicators. Among the 190 cases of PD patients, there were 81 cases had incurred biochemical leak including 36 cases with no progression, 41 cases progressing to grade B and 4 cases progressing from grade B to grade C.Univariate analysis showed CT value of pancreatic body, acute pancreatitis preoperatively, and the platelet(PLT), prealbumin, ALT on postoperative 3-4 days were risk factors for progressing from biochemical leak to grade B. Multivariate analysis showed CT value, acute pancreatitis preoperatively, and the PLT on postoperative 3-4 days were independent risk factors. Postoperatively patients with biochemical leak got acute pancreatitis before surgery were more likely to progress to grade B as well as those with the lower CT value before surgery or the lower PLT at 3-4 days after surgery. The AUC of CT value was 0.734. Using 39.8 HU as CT value, the sensitivity, specificity and Youden index were 73.2%, 75.0% and 0.482, with the highest performance prediction. The analysis of CT value of pancreatic body for standardized judgment of pancreas texture, the rational treatments of acute pancreatitis preoperatively and appropriate administration of patients with platelet-related drugs during perioperative period can respectively forecast and prevent progressing from biochemical leak to grade B.
早期分析胰十二指肠切除术（PD）后生化漏进展为B级胰瘘的危险因素。对2014年11月至2017年4月在中国医科大学附属第一医院发生生化漏的190例患者的全部临床资料进行回顾性分析。其中男性112例，女性78例，年龄（73±6）岁（范围：22至77岁）。采用单因素和逻辑回归多因素模型分析生化漏进展为B级的所有潜在因素。选择这些具有统计学意义的术前指标绘制受试者操作特征（ROC）曲线，计算曲线下面积（AUC）并评估预测值。对于预测值高于中等水平的指标，通过使用不同的截断值计算约登指数和其他指标来确定临界值的最大预测性能。在190例PD患者中，有81例发生生化漏，其中36例无进展，41例进展为B级，4例从B级进展为C级。单因素分析显示胰体CT值、术前急性胰腺炎以及术后3 - 4天的血小板（PLT）、前白蛋白、谷丙转氨酶（ALT）是生化漏进展为B级的危险因素。多因素分析显示CT值、术前急性胰腺炎以及术后3 - 4天的PLT是独立危险因素。术后发生生化漏且术前有急性胰腺炎的患者比术前CT值较低或术后3 - 4天PLT较低的患者更易进展为B级。CT值的AUC为0.734。以39.8 HU作为CT值时，敏感性、特异性和约登指数分别为73.2%、75.0%和0.482，预测性能最佳。分析胰体CT值以标准化判断胰腺质地、术前合理治疗急性胰腺炎以及围手术期对血小板相关药物进行合理给药，可分别预测和预防生化漏进展为B级。
