Department of Visceral-, Thoracic- and Vascular Surgery, Philipps-University Marburg, Germany.
Department of Visceral-, Thoracic- and Vascular Surgery, Philipps-University Marburg, Germany.
Int J Surg. 2020 Apr;76:53-58. doi: 10.1016/j.ijsu.2020.02.025. Epub 2020 Feb 25.
C-reactive protein (CRP) and procalcitonin (PCT) have shown to be reliable predictors of inflammatory complications and anastomotic leak after colorectal surgery. Their predictive value after partial pancreaticoduodenectomy (PD) remains unclear.
All consecutive pancreaticoduodenectomies (2009-2018) at our hospital were included. Drain amylase was evaluated on postoperative day (POD) 1, serum CRP and PCT were evaluated on POD 1-3. Receiver-operating characteristics curves were performed and significant cut-off values were tested using logistic regression.
Among 188 patients who underwent partial PD, clinically relevant pancreatic fistulas (POPF) occurred in 30 (16%) patients, including 20 (10.6%) with Grade B and 10 (5.3%) patients with Grade C. Postoperative complications (Clavien-Dindo ≥ III) were reported in 46 (24.5%) patients, including Grade IIIa in 16 (8.5%), IIIb in 18 (9.6%), IVa in 3 (1.6%), IVb in 2 (1.1%) and V in 7 (3.7%) patients. Drain amylase on POD 1 showed the largest area under the curve (0.872, p < 0.001), followed by CRP (0.803, p < 0.001) and PCT on POD 3 (0.651, p < 0.011). Drain amylase on POD 1 > 303 U/l (OR 0.045, 95% CI 0.010-0.195, p < 0.001), CRP > 203 mg/l (OR 0.098, 95% CI 0.041-0.235, p < 0.001) and PCT > 0.85 μg/l (OR 0.393, 95%CI 0.178-0.869, p = 0.02) were significant predictors of relevant POPF in the univariate analysis. CRP > 203 mg/l (OR 0.098, 95% CI 0.024-0.403, p = 0.001) and drain amylase > 303 U/l (OR 0.064, 95% CI 0.007-0.554, p = 0.01) remained independent predictors in the multivariable analysis. The combination of drain amylase on POD 1 and CRP on POD 3 had a sensitivity and specificity of 87.4% and 90.9% to predict relevant POPF.
Drain amylase on POD 1 and CRP on POD 3 can accurately predict clinically relevant POPF after partial pancreaticoduodenectomy. The accuracy of PCT on POD 3 is limited.
C 反应蛋白（CRP）和降钙素原（PCT）已被证明是结直肠手术后炎症并发症和吻合口漏的可靠预测指标。其在胰十二指肠部分切除术（PD）后的预测价值仍不清楚。
纳入我院 2009 年至 2018 年所有连续进行的胰十二指肠切除术患者。术后第 1 天评估引流淀粉酶，第 1-3 天评估血清 CRP 和 PCT。绘制受试者工作特征曲线，使用逻辑回归测试显著截断值。
在 188 例接受部分 PD 的患者中，30 例（16%）发生临床相关的胰瘘（POPF），其中 20 例（10.6%）为 B 级，10 例（5.3%）为 C 级。46 例（24.5%）患者发生术后并发症（Clavien-Dindo≥III 级），其中 16 例（8.5%）为 IIIa 级，18 例（9.6%）为 IIIb 级，IVa 级 3 例（1.6%），IVb 级 2 例（1.1%），V 级 7 例（3.7%）。术后第 1 天的引流淀粉酶曲线下面积最大（0.872，p<0.001），其次是 CRP（0.803，p<0.001）和第 3 天的 PCT（0.651，p<0.011）。术后第 1 天的引流淀粉酶>303 U/l（OR 0.045，95%CI 0.010-0.195，p<0.001）、CRP>203 mg/l（OR 0.098，95%CI 0.041-0.235，p<0.001）和 PCT>0.85 μg/l（OR 0.393，95%CI 0.178-0.869，p=0.02）是 POPF 的显著预测因素。CRP>203 mg/l（OR 0.098，95%CI 0.024-0.403，p=0.001）和引流淀粉酶>303 U/l（OR 0.064，95%CI 0.007-0.554，p=0.01）在多变量分析中仍然是独立的预测因素。术后第 1 天的引流淀粉酶和第 3 天的 CRP 联合检测对预测临床相关 POPF 的灵敏度和特异性分别为 87.4%和 90.9%。
术后第 1 天的引流淀粉酶和第 3 天的 CRP 可准确预测胰十二指肠部分切除术后临床相关的 POPF。PCT 在第 3 天的准确性有限。
