Zhou Quanyu, Xia Yuxiao, Lei Zehua
Department of Hepatobiliary and Pancreatic Surgery, The People's Hospital of Leshan City, Leshan, Sichuan, 614000, People's Republic of China.
Department of Nuclear Medicine, The Affiliated Hospital, Southwest Medical University, No 15 TaiPing St, Jiangyang District, Luzhou, 64600, Sichuan, People's Republic of China.
BMC Surg. 2020 May 6;20(1):90. doi: 10.1186/s12893-020-00755-2.
To investigate the early prediction value of procalcitonin (PCT) in pancreatic fistula (POPF) after pancreatoduodenectomy (PD).
Retrospective analysis of clinical data of 67 patients undergoing pancreaticoduodenectomy (PD) and 19 patients undergoing distalpancreatectomy (DP) were performed in the Department of Hepatobiliary Surgery, Leshan People's Hospital from January 2017 to December 2018. All patients were divided into POPF group and non-POPF group depending on the presence of pancreatic fistula. And fistulas were classified according to the ISGPF classification scheme. Plasma PCT levels, serum CRP concentration, and WBC counts were assessed preoperatively and on postoperative days (PODs) 1, 3, and 5. Statistical analyses were performed with statistical software. The ROC curve was used to analyze the efficacy of PCT and CRP in POPF prediction after surgery and determine their Cut-off value.
There were no statistically significant differences identified in age, gender, BMI, diabetes, abdominal surgery history, preoperative laboratory data, operation time, intraoperative bleeding volume, tumor nature and medical expenses of PD patients between the two groups (P > 0.05). While the incidence of postoperative hyperglycemia, postoperative ICU rate and postoperative hospital stay were statistically significant (P < 0.05). The AUC for PCT diagnosis of pancreatic fistula 1 day after surgery was 0.77 (95% CI: 0.675 ~ 0.860). Compared with CRP [0.53 (95% CI: 0.420 ~ 0.639)] and WBC [0.60 (95% CI: 0.490 ~ 0.705)], the optimal cut-off value (cut-off) was 0.67 μg/L. At this time, the sensitivity and specificity of detecting pancreatic fistula were 73.68 and 76.12%, respectively. The results at 3 days after surgery were similar to those at 5 days after surgery. And DP patients had similar results as PD patients.
The PCT is valuable for early prediction of pancreatic fistula after Pancreaticoduodenectomy.
探讨降钙素原（PCT）在胰十二指肠切除术（PD）后胰瘘（POPF）中的早期预测价值。
回顾性分析2017年1月至2018年12月在乐山市人民医院肝胆外科接受胰十二指肠切除术（PD）的67例患者和接受胰体尾切除术（DP）的19例患者的临床资料。根据是否存在胰瘘将所有患者分为胰瘘组和非胰瘘组。并根据国际胰瘘研究小组（ISGPF）分类方案对瘘进行分类。术前及术后第1、3、5天评估血浆PCT水平、血清CRP浓度和白细胞计数。使用统计软件进行统计分析。采用ROC曲线分析PCT和CRP在术后胰瘘预测中的效能并确定其截断值。
两组PD患者在年龄、性别、BMI、糖尿病、腹部手术史、术前实验室数据、手术时间、术中出血量、肿瘤性质及医疗费用方面差异均无统计学意义（P＞0.05）。而术后高血糖发生率、术后ICU入住率及术后住院时间差异有统计学意义（P＜0.05）。术后第1天PCT诊断胰瘘的AUC为0.77（95%CI：0.675～0.860）。与CRP[0.53（95%CI：0.420～0.639）]和白细胞[0.60（95%CI：0.490～0.705）]相比，最佳截断值为0.67μg/L。此时，检测胰瘘的敏感度和特异度分别为73.68%和76.12%。术后第3天结果与术后第5天相似。且DP患者结果与PD患者相似。
PCT对胰十二指肠切除术后胰瘘的早期预测有价值。
