Department of Surgery, Shiga University of Medical Science, Setatsukinowa-cho, Otsu, Shiga, 520-2192, Japan.
Langenbecks Arch Surg. 2020 May;405(3):325-336. doi: 10.1007/s00423-020-01880-5. Epub 2020 Apr 23.
Perianastomotic fluid collection (PFC) is one of the postoperative complications of pancreaticoduodenectomy (PD). However, no studies have investigated the clinical significance of PFC location and volume during the early postoperative period. This study aimed to assess the association between PFC during the early postoperative period and postoperative complications.
Medical records of 148 patients who had undergone PD and computed tomography (CT) on postoperative day 4 were retrospectively reviewed. The location-superior, inferior, ventral, dorsal, or splenic hilum-and PFC index, which is the estimated volume of fluid collection, were determined using CT. The associations between postoperative complication and the presence of PFC, and PFC index according to the location, were assessed.
The PFC group included 102 patients (69%). Postoperative pancreatic fistula (POPF) and organ/space surgical site infection (SSI) were more frequent in the PFC group (42% vs 9%, p < 0.001 and 29% vs 11%, p = 0.020, respectively). Additionally, the PFC index was larger in patients who developed POPF, organ/space SSI, or pseudoaneurysm (81 cm vs 19 cm, p < 0.001; 75 cm vs 30 cm, p = 0.001; and 185 cm vs 31 cm, p < 0.001, respectively). Furthermore, superior and ventral PFCs were associated with pseudoaneurysm (11% vs 0%, p = 0.006 and 14% vs 1%, p = 0.002, respectively), whereas inferior and dorsal PFCs were associated with deep incisional SSI (9% vs 0%, p = 0.027 and 8% vs 1%, p = 0.034, respectively).
The PFC location during the early postoperative period is associated with postoperative complications. Our findings may help determine the optimal location of prophylactic drains.
胰十二指肠切除术（PD）后吻合口周围积液（PFC）是一种术后并发症。然而，目前尚无研究探讨术后早期 PFC 的位置和量与临床并发症的关系。本研究旨在评估术后早期 PFC 与术后并发症之间的相关性。
回顾性分析 148 例行 PD 且术后第 4 天行 CT 检查的患者的病历资料。使用 CT 确定 PFC 的位置（上、下、前、后或脾门）和 PFC 指数（估计的积液量）。评估术后并发症与 PFC 存在与否以及根据位置的 PFC 指数之间的关系。
PFC 组 102 例（69%）。PFC 组患者术后胰瘘（POPF）和器官/腔隙手术部位感染（SSI）的发生率更高（42%比 9%，p<0.001；29%比 11%，p=0.020）。此外，发生 POPF、器官/腔隙 SSI 或假性动脉瘤的患者 PFC 指数更大（81cm 比 19cm，p<0.001；75cm 比 30cm，p=0.001；185cm 比 31cm，p<0.001）。此外，上、前 PFC 与假性动脉瘤相关（11%比 0%，p=0.006；14%比 1%，p=0.002），而下、后 PFC 与深部切口 SSI 相关（9%比 0%，p=0.027；8%比 1%，p=0.034）。
术后早期 PFC 的位置与术后并发症相关。我们的研究结果可能有助于确定预防性引流的最佳位置。
