尼泊尔一家三级保健中心胰腺形态指数预测术后胰瘘的价值。

Pancreatic Configuration Index in Predicting Postoperative Pancreatic Fistula in a Tertiary Care Center in Nepal.

机构信息

Department of Surgery, Patan Hospital, Patan Academy of Health Sciences Lagankhel, Lalitpur, Nepal.

Department of Gastrointestinal and General Surgery, Tribhuvan University, Teaching Hospital, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal.

出版信息

J Nepal Health Res Counc. 2020 Sep 7;18(2):172-177. doi: 10.33314/jnhrc.v18i2.2395.

DOI:10.33314/jnhrc.v18i2.2395

PMID:32969372

Abstract

BACKGROUND

Post-operative pancreatic fistula is the single most common and most significant cause of post-operative morbidity and perioperative mortality. Identification of at risk patient preoperatively help to take policy of extra vigilance to act on time. This study evaluated the predictive role and cut-off value of pancreatic configuration index to predict post-operative pancreatic fistula.

METHODS

This was a prospective observational study in patients who had undergone pancreaticoduodenectomy from March 2017 to June 2018 at Tribhuvan University Teaching Hospital, Kathmandu, Nepal. The patients with age <16 years, those who underwent re-exploration or mortality before 3rd postoperative day, additional surgery besides pancreaticoduodenectomy were excluded from the study. Pancreatic configuration index was calculated as a ratio of pancreatic parenchymal thickness and pancreatic duct diameter. Predictive value of pancreatic configuration index in predicting post-operative pancreatic fistula was evaluated.

RESULTS

Among 58 patients, 9 were excluded from study and 49 patients were included in the study. The mean age of the patients was 56.6 ± 13.9 years (21 to 79 years) and male to female ratio was 1.1:1 (26 vs 23). Post-operative pancreatic fistula developed in 13/49 (26.5%) patients. On both univariate and multivariate analysis, pancreatic texture (p = 0.022), main pancreatic duct diameter at neck (p = 0.002) and pancreatic configuration index (p = 0.001) were significantly associated with development of post-operative pancreatic fistula. The sensitivity and specificity of pancreatic configuration index to predict post-operative pancreatic fistula are 92.3% and 91.7% with positive predictive value of 80% and negative predictive value of 97.1%.

CONCLUSIONS

Pancreatic configuration index is a useful preoperative predictor of post-operative pancreatic fistula after pancreaticoduodenectomy.

摘要

背景

术后胰腺瘘是术后发病率和围手术期死亡率的最常见和最重要的单一原因。术前识别高危患者有助于采取额外警惕的政策，及时采取行动。本研究评估了胰腺形态指数对预测术后胰腺瘘的预测作用和临界值。

方法

这是 2017 年 3 月至 2018 年 6 月在尼泊尔加德满都特里布万大学教学医院接受胰十二指肠切除术的患者的前瞻性观察研究。排除年龄<16 岁、术后第 3 天前再次探查或死亡、除胰十二指肠切除术外还进行其他手术的患者。胰腺形态指数计算为胰腺实质厚度与胰管直径的比值。评估胰腺形态指数预测术后胰腺瘘的预测价值。

结果

在 58 例患者中，有 9 例被排除在研究之外，有 49 例患者被纳入研究。患者的平均年龄为 56.6±13.9 岁（21 至 79 岁），男女比例为 1.1:1（26 例与 23 例）。术后胰腺瘘发生在 13/49（26.5%）例患者中。在单因素和多因素分析中，胰腺质地（p=0.022）、颈部主胰管直径（p=0.002）和胰腺形态指数（p=0.001）与术后胰腺瘘的发生显著相关。胰腺形态指数预测术后胰腺瘘的敏感性和特异性分别为 92.3%和 91.7%，阳性预测值为 80%，阴性预测值为 97.1%。