胰十二指肠切除术后的引流量是术后并发症的一个有用的预警信号。
Drain output volume after pancreaticoduodenectomy is a useful warning sign for postoperative complications.
机构信息
Department of Surgery, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama, 330-8503, Japan.
出版信息
BMC Surg. 2021 Jun 3;21(1):279. doi: 10.1186/s12893-021-01285-1.
INTRODUCTION
The drain output volume (DOV) after pancreaticoduodenectomy (PD) is an easily assessable indicator in clinical settings. We explored the utility of the DOV as a possible warning sign of complications after PD.
METHODS
A total of 404 patients undergoing PD were considered for inclusion. The predictability of the DOV for overall morbidity, major complications, intraabdominal infection (IAI), clinically relevant (CR) postoperative pancreatic fistula (POPF), CR delayed gastric emptying (DGE), CR chyle leak (CL), and CR post-pancreatectomy hemorrhaging (PPH) was evaluated.
RESULTS
One hundred (24.8%) patients developed major complications, and 131 (32.4%) developed IAI. Regarding CR post-pancreatectomy complications, 75 (18.6%) patients developed CR-POPF, 23 (5.7%) developed CR-DGE, 20 (5.0%) developed CR-CL, and 28 (6.9%) developed CR-PPH. The median DOV on postoperative day (POD) 1 and POD 3 was 266 and 234.5 ml, respectively. A low DOV on POD 1 was an independent predictor of CR-POPF, and a high DOV on POD 3 was an independent predictor of CR-CL. A receiver operating characteristics (ROC) analysis revealed that the DOV on POD 1 had a negative predictive value (area under the curve [AUC] 0.655, sensitivity 65.0%, specificity 65.3%, 95% confidence interval [CI]: 0.587-0.724), with a calculated optimal cut-off value of 227 ml. An ROC analysis also revealed that the DOV on POD 3 had a positive predictive value (AUC 0.753, sensitivity 70.1%, specificity 75.0%, 95% CI: 0.651-0.856), with a calculated optimal cut-off value of 332 ml.
CONCLUSION
A low DOV on POD 1 might be a postoperative warning sign for CR-POPF, similar to high drain amylase (DA) on POD 1, high DA on POD 3, and high CRP on POD 3. When the DOV on POD 1 after PD was low, surgeons should evaluate the reasons of a low DOV. A high DOV on POD 3 was a postoperative warning sign CR-CL, and might require an appropriate management of protein loss.
简介
胰腺十二指肠切除术后（PD）的引流量（DOV）是临床评估中易于评估的指标。我们探讨了 DOV 作为 PD 后并发症预警信号的可能性。
方法
共纳入 404 例行 PD 的患者。评估 DOV 对总发病率、主要并发症、腹腔内感染（IAI）、临床相关（CR）术后胰瘘（POPF）、CR 延迟胃排空（DGE）、CR 乳糜漏（CL）和 CR 胰腺切除术后出血（PPH）的预测价值。
结果
100 例（24.8%）患者发生主要并发症，131 例（32.4%）发生 IAI。关于 CR 胰腺切除术后并发症，75 例（18.6%）患者发生 CR-POPF，23 例（5.7%）发生 CR-DGE，20 例（5.0%）发生 CR-CL，28 例（6.9%）发生 CR-PPH。术后第 1 天（POD）和第 3 天（POD3）的中位 DOV 分别为 266 和 234.5ml。POD1 时的低 DOV 是 CR-POPF 的独立预测因子，而 POD3 时的高 DOV 是 CR-CL 的独立预测因子。受试者工作特征（ROC）分析显示，POD1 时的 DOV 具有负预测值（曲线下面积 [AUC]0.655，敏感性 65.0%，特异性 65.3%，95%置信区间 [CI]：0.587-0.724），计算得出的最佳截断值为 227ml。ROC 分析还显示，POD3 时的 DOV 具有阳性预测值（AUC0.753，敏感性 70.1%，特异性 75.0%，95%CI：0.651-0.856），计算得出的最佳截断值为 332ml。
结论
POD1 时的低 DOV 可能是 CR-POPF 的术后预警信号，类似于 POD1 时的高引流淀粉酶（DA）、POD3 时的高 DA 和 POD3 时的高 CRP。当 PD 后第 1 天的 DOV 较低时，外科医生应评估低 DOV 的原因。POD3 时的高 DOV 是术后 CR-CL 的预警信号，可能需要对蛋白质丢失进行适当的管理。
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