归咎于损伤：与择期切除术相比，创伤是胰体尾切除术后胰瘘的一个危险因素。
Blame it on the injury: Trauma is a risk factor for pancreatic fistula following distal pancreatectomy compared with elective resection.
机构信息
From the Health Sciences Center (K.T.M., T.G., Z.S., A.L., C.S.B., A.J., P.K.M., B.C.A., B.H.E., J.S.L.), University of Oklahoma, Oklahoma City, Oklahoma; Medical School (C.B.S.), University of Minnesota, Minneapolis, Minnesota.
出版信息
J Trauma Acute Care Surg. 2019 Dec;87(6):1289-1300. doi: 10.1097/TA.0000000000002495.
BACKGROUND
Postoperative pancreatic fistula (POPF) remains a significant source of morbidity following distal pancreatectomy (DP). There is a lack of information regarding the impact of trauma on POPF rates when compared with elective resection. We hypothesize that trauma will be a significant risk factor for the development of POPF following DP.
METHODS
A retrospective, single-institution review of all patients undergoing DP from 1999 to 2017 was performed. Outcomes were compared between patients undergoing DP for traumatic injury to those undergoing elective resection. Univariate and multivariable analyses were performed using SAS (version 9.4).
RESULTS
Of the 372 patients who underwent DP during the study period, 298 met inclusion criteria: 38 DPs for trauma (TDP), 260 elective DPs (EDP). Clinically significant grade B or C POPFs occurred in 17 (44.7%) of 38 TDPs compared with 41 (15.8%) of 260 EDPs (p < 0.0001). On multivariable analysis, traumatic injury was found to be independently predictive of developing a grade B or C POPF (odds ratio, 4.3; 95% confidence interval, 2.10-8.89). Age, sex, and wound infection were highly correlated with traumatic etiology and therefore were not retained in the multivariable model. When analyzing risk factors for each group (trauma vs. elective) separately, we found that TDP patients who developed POPFs had less sutured closure of their duct, higher infectious complications, and longer hospital stays, while EDP patients that suffered POPFs were more likely to be male, younger in age, and at a greater risk for infectious complications. Lastly, in a subgroup analysis involving only patients with drains left postoperatively, trauma was an independent predictor of any grade of fistula (A, B, or C) compared with elective DP (odds ratio, 8.6; 95% confidence interval, 3.09-24.15), suggesting that traumatic injury is risk factor for pancreatic stump closure disruption following DP.
CONCLUSION
To our knowledge, this study represents the largest cohort of patients comparing pancreatic leak rates in traumatic versus elective DP, and demonstrates that traumatic injury is an independent risk factor for developing an ISGPF grade B or C pancreatic fistula following DP.
LEVEL OF EVIDENCE
Prognostic study, Therapeutic, level III.
背景
胰瘘（POPF）仍然是远端胰腺切除术（DP）后发病率的重要来源。与择期切除术相比，关于创伤对 POPF 发生率的影响的信息有限。我们假设创伤将是 DP 后 POPF 发展的一个重要危险因素。
方法
对 1999 年至 2017 年期间所有接受 DP 的患者进行了回顾性、单机构研究。比较了因创伤而行 DP 与因择期切除而行 DP 的患者的结果。使用 SAS（版本 9.4）进行单变量和多变量分析。
结果
在研究期间接受 DP 的 372 例患者中，298 例符合纳入标准：38 例因创伤而行 DP（TDP），260 例行择期 DP（EDP）。38 例 TDP 中有 17 例（44.7%）发生临床意义的 B 级或 C 级 POPF，而 260 例 EDP 中有 41 例（15.8%）（p < 0.0001）。多变量分析显示，创伤是发生 B 级或 C 级 POPF 的独立预测因素（优势比，4.3；95%置信区间，2.10-8.89）。年龄、性别和伤口感染与创伤病因高度相关，因此未保留在多变量模型中。当分别分析两组（创伤与择期）的危险因素时，我们发现发生 POPF 的 TDP 患者的胰管缝合关闭较少，感染性并发症更多，住院时间更长，而发生 POPF 的 EDP 患者更年轻，男性，感染性并发症风险更高。最后，在仅涉及术后留置引流管的患者的亚组分析中，与择期 DP 相比，创伤是任何等级瘘管（A、B 或 C）的独立预测因素（优势比，8.6；95%置信区间，3.09-24.15），这表明创伤是 DP 后胰腺残端闭合破裂的危险因素。
结论
据我们所知，这项研究是比较创伤性与择期 DP 患者胰漏率的最大队列研究之一，表明创伤是 DP 后发生 ISGPF 分级 B 或 C 胰瘘的独立危险因素。
证据水平
预后研究，治疗性，III 级。
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