胰十二指肠切除术后C级胰瘘的危险因素：一项大型前瞻性多中心日本-台湾合作研究。

Risk factors for pancreatic fistula grade C after pancreatoduodenectomy: A large prospective, multicenter Japan-Taiwan collaboration study.

作者信息

Hirono Seiko, Shimokawa Toshio, Nagakawa Yuichi, Shyr Yi-Ming, Kawai Manabu, Matsumoto Ippei, Satoi Sohei, Yoshitomi Hideyuki, Okabayashi Takehiro, Motoi Fuyuhiko, Amano Ryosuke, Murakami Yoshiaki, Hirano Satoshi, Kawamoto Kazuyuki, Nakamori Shoji, Shan Yan-Shen, Kobayashi Shinjiro, Nitta Hiroyuki, Matsukawa Hiroyoshi, Uchiyama Kazuhisa, Hsu Chih-Po, Kitami Chie, Yamamoto Masakazu, Hwang Tsann-Long, Yamaue Hiroki

机构信息

Second Department of Surgery, School of Medicine, Wakayama Medical University, Wakayama, Japan.

Clinical Study Support Center, School of Medicine, Wakayama Medical University, Wakayama, Japan.

出版信息

J Hepatobiliary Pancreat Sci. 2020 Sep;27(9):622-631. doi: 10.1002/jhbp.799. Epub 2020 Aug 6.

DOI:10.1002/jhbp.799

PMID:32621787

Abstract

BACKGROUND/PURPOSE: Grade C postoperative pancreatic fistula (POPF), as defined by International Study Group of Pancreatic Fistula (ISGPF), is the most life-threatening complication after pancreatoduodenectomy (PD). This study aims to evaluate risk factors for Grade C POPF after PD.

METHODS

This is a prospective, multicenter study based in Japan and Taiwan. Between December 2014 and May 2017, 3022 patients were enrolled in this study and 2762 patients were analyzed. We analyzed risk factors of Grade C POPF based on the updated 2016 ISGPF scheme (organ failure, reoperation, and/or death).

RESULTS

Among 2762 patients, 46 patients (1.7%) developed Grade C POPF after PD. The mortality rate of the 46 patients with Grade C POPF was 37.0%. On the multivariate analysis, six independent risk factors for Grade C POPF were found; BMI ≥ 25.0 kg/m , chronic steroid use, preoperative serum albumin <3.0 mg/dL, soft pancreas, operative time ≥480 minutes, and intraoperative transfusion. The c-statistic of our risk scoring model for Grade C POPF using these risk factors was 0.77. The score was significantly higher in Grade C POPF than in Grade B POPF (P < .001) or none/biochemical leak (P < .001).

CONCLUSIONS

This prospective study showed risk factors for Grade C POPF after PD.

摘要

背景/目的：根据国际胰腺瘘研究组（ISGPF）的定义，C级术后胰瘘（POPF）是胰十二指肠切除术（PD）后最危及生命的并发症。本研究旨在评估PD术后C级POPF的危险因素。

方法

这是一项基于日本和台湾的前瞻性多中心研究。2014年12月至2017年5月期间，3022例患者纳入本研究，对2762例患者进行分析。我们根据2016年更新的ISGPF方案（器官衰竭、再次手术和/或死亡）分析C级POPF的危险因素。

结果

2762例患者中，46例（1.7%）PD术后发生C级POPF。46例C级POPF患者的死亡率为37.0%。多因素分析发现C级POPF的六个独立危险因素；体重指数≥25.0kg/m²、长期使用类固醇、术前血清白蛋白<3.0mg/dL、胰腺质地柔软、手术时间≥480分钟和术中输血。使用这些危险因素的C级POPF风险评分模型的c统计量为0.77。C级POPF患者的评分显著高于B级POPF患者（P<.001）或无/生化漏患者（P<.001）。