Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center, Shizuoka, Japan.
J Hepatobiliary Pancreat Sci. 2020 Dec;27(12):1002-1010. doi: 10.1002/jhbp.820. Epub 2020 Sep 18.
Latent pancreatic fistula (LPF) is difficult to diagnose during the early postoperative phase because of initially normal drain fluid amylase (DFA) levels. The present study investigated the clinical significance and risk factors of LPF after pancreatoduodenectomy.
A total of 662 patients who underwent pancreatoduodenectomy between 2010 and 2018 were retrospectively analyzed. LPF was defined as pancreatic fistula that developed later regardless of initially low DFA levels.
Among the 372 patients with DFA ≤375 U/L (three times the upper limit for serum) on postoperative day (POD) 3, LPF occurred in 37 (10%). The rates of postoperative hemorrhaging (11% vs 1.5%), intraabdominal abscess (57% vs 7.2%) and reintervention (46% vs 2.7%) were significantly higher in the patients with LPF than in those without LPF. A multivariate analysis revealed that a body mass index ≥25 kg/m , a non-combined portal vein resection, a DFA on POD 1 ≥650 U/L and a C-reactive protein level on POD 3 ≥11 mg/dL were independent risk factors for LPF.
Latent pancreatic fistula was significantly associated with severe complications and worse outcomes after pancreatoduodenectomy. Early drain removal may be unfavorable for patients with some of these risk factors.
由于术后早期引流液淀粉酶（DFA）水平正常，潜伏性胰瘘（LPF）很难在术后早期诊断。本研究探讨了胰十二指肠切除术后 LPF 的临床意义和危险因素。
回顾性分析了 2010 年至 2018 年间接受胰十二指肠切除术的 662 例患者。将术后第 3 天 DFA≤375 U/L（血清上限的 3 倍）的 372 例患者定义为 LPF，无论最初的 DFA 水平是否较低。
在术后第 3 天 DFA≤375 U/L（血清上限的 3 倍）的 372 例患者中，有 37 例（10%）发生 LPF。LPF 患者术后出血（11%比 1.5%）、腹腔脓肿（57%比 7.2%）和再次干预（46%比 2.7%）的发生率明显高于无 LPF 患者。多因素分析显示，体质指数≥25 kg/m 2 、非联合门静脉切除术、术后第 1 天 DFA≥650 U/L 和术后第 3 天 C 反应蛋白水平≥11 mg/dL 是 LPF 的独立危险因素。
潜伏性胰瘘与胰十二指肠切除术后严重并发症和不良结局显著相关。对于存在这些危险因素的患者，早期拔管可能不利。
