腹腔镜胰十二指肠切除术后胰瘘的预测因素
Predictive factors of postoperative pancreatic fistula after laparoscopic pancreatoduodenectomy.
作者信息
Jin Jikuan, Xiong Guangbing, Li Jiali, Guo Xingjun, Wang Min, Li Zhen, Zhu Feng, Qin Renyi
机构信息
Department of Biliary-Pancreatic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
出版信息
Ann Transl Med. 2021 Jan;9(1):41. doi: 10.21037/atm-20-1411.
BACKGROUND
Clinically relevant postoperative pancreatic fistula (CR-POPF) continues to be a major contributor to morbidity after pancreaticoduodenectomy (PD), but it remains unclear what risk factors can precisely predict the development of CR-POPF after laparoscopic pancreatoduodenectomy (LPD). We thus aimed to identify the risk factors for predicting CR-POPF after LPD.
METHODS
A total of 388 consecutive patients who underwent LPD at our institution between July 2014 and December 2018 were identified. All data, including pre-, intra-, and postoperative risk factors associated with CR-POPF defined by the International Study Group of Pancreatic Fistula, were collected retrospectively. To evaluate the predictive performance of the risk factor models, areas under the receiver operating characteristic curve (ROC) were determined.
RESULTS
CR-POPF was observed in 31 patients (8.0%) with significant association observed with body mass index (BMI), visceral fat area (VFA), subcutaneous fat area (SFA), total fat area (TFA), intra-abdominal fat thickness, main pancreatic duct width, soft pancreatic texture, operative time, underlying pathology, and albumin (Alb) on postoperative days (POD) 1--3. Multivariate analyses revealed that VFA >82 cm [odds ratio (OR) =11.088; P=0.029], main pancreatic duct width <3 mm (OR =7.701; P=0.001), soft pancreatic texture (OR =12.543; P=0.022), and operative time >320 min (OR =6.061; P<0.001) were independent risk factors for CR-POPF after LPD. Areas under the ROC curve (AUC) analysis revealed the pancreatic texture was the strongest single predictor (AUC =0.854) of CR-POPF, and pancreatic texture + pancreatic duct width was the best two-predictor model (AUC =0.904). Meanwhile, our findings indicated an association between the TFA >221 cm (OR =8.637; P=0.001) and VFA >82 cm (OR =7.009; P<0.001) with soft pancreatic texture.
CONCLUSIONS
Soft pancreatic texture, VFA >82 cm, main pancreatic duct width <3 mm, and operative time >320 min were independent predictive risk factors of CR-POPF for LPD.
背景
临床相关的术后胰瘘（CR-POPF）仍然是胰十二指肠切除术（PD）后发病的主要原因，但目前尚不清楚哪些危险因素能够准确预测腹腔镜胰十二指肠切除术（LPD）后CR-POPF的发生。因此，我们旨在确定LPD后预测CR-POPF的危险因素。
方法
我们纳入了2014年7月至2018年12月期间在我院连续接受LPD的388例患者。回顾性收集所有数据，包括与胰瘘国际研究组定义的CR-POPF相关的术前、术中和术后危险因素。为了评估危险因素模型的预测性能，我们确定了受试者操作特征曲线（ROC）下的面积。
结果
31例患者（8.0%）发生CR-POPF，其与体重指数（BMI）、内脏脂肪面积（VFA）、皮下脂肪面积（SFA）、总脂肪面积（TFA）、腹内脂肪厚度、主胰管宽度、胰腺质地柔软、手术时间、基础病理以及术后第1-3天的白蛋白（Alb）显著相关。多因素分析显示，VFA>82 cm [比值比（OR）=11.088；P=0.029]、主胰管宽度<3 mm（OR =7.701；P=0.001）、胰腺质地柔软（OR =12.543；P=0.022）以及手术时间>320分钟（OR =6.061；P<0.001）是LPD后CR-POPF的独立危险因素。ROC曲线下面积（AUC）分析显示，胰腺质地是CR-POPF最强的单一预测因素（AUC =0.854），胰腺质地+主胰管宽度是最佳的双因素预测模型（AUC =0.904）。同时，我们的研究结果表明TFA>221 cm（OR =8.637；P=0.001）和VFA>82 cm（OR =7.009；P<0.001）与胰腺质地柔软有关。
结论
胰腺质地柔软、VFA>82 cm、主胰管宽度<3 mm以及手术时间>320分钟是LPD后CR-POPF的独立预测危险因素。
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