胰十二指肠切除术后急性胰腺炎（PPAP）：来自国际胰腺手术研究组（ISGPS）的定义与分级

Postpancreatectomy Acute Pancreatitis (PPAP): Definition and Grading From the International Study Group for Pancreatic Surgery (ISGPS).

作者信息

Marchegiani Giovanni, Barreto Savio George, Bannone Elisa, Sarr Michael, Vollmer Charles M, Connor Saxon, Falconi Massimo, Besselink Marc G, Salvia Roberto, Wolfgang Christopher L, Zyromski Nicholas J, Yeo Charles J, Adham Mustapha, Siriwardena Ajith K, Takaori Kyoichi, Hilal Mohammad Abu, Loos Martin, Probst Pascal, Hackert Thilo, Strobel Oliver, Busch Olivier R C, Lillemoe Keith D, Miao Yi, Halloran Christopher M, Werner Jens, Friess Helmut, Izbicki Jakob R, Bockhorn Maximillian, Vashist Yogesh K, Conlon Kevin, Passas Ioannis, Gianotti Luca, Del Chiaro Marco, Schulick Richard D, Montorsi Marco, Oláh Attila, Fusai Giuseppe Kito, Serrablo Alejandro, Zerbi Alessandro, Fingerhut Abe, Andersson Roland, Padbury Robert, Dervenis Christos, Neoptolemos John P, Bassi Claudio, Büchler Markus W, Shrikhande Shailesh V

机构信息

Department of Surgery, The Pancreas Institute, Verona University Hospital, Verona, Italy.

Division of Surgery and Perioperative Medicine, Flinders Medical Centre, Bedford Park, Adelaide, South Australia, Australia.

出版信息

Ann Surg. 2022 Apr 1;275(4):663-672. doi: 10.1097/SLA.0000000000005226.

DOI:10.1097/SLA.0000000000005226

PMID:34596077

Abstract

OBJECTIVE

The ISGPS aimed to develop a universally accepted definition for PPAP for standardized reporting and outcome comparison.

BACKGROUND

PPAP is an increasingly recognized complication after partial pancreatic resections, but its incidence and clinical impact, and even its existence are variable because an internationally accepted consensus definition and grading system are lacking.

METHODS

The ISGPS developed a consensus definition and grading of PPAP with its members after an evidence review and after a series of discussions and multiple revisions from April 2020 to May 2021.

RESULTS

We defined PPAP as an acute inflammatory condition of the pancreatic remnant beginning within the first 3 postoperative days after a partial pancreatic resection. The diagnosis requires (1) a sustained postoperative serum hyperamylasemia (POH) greater than the institutional upper limit of normal for at least the first 48 hours postoperatively, (2) associated with clinically relevant features, and (3) radiologic alterations consistent with PPAP. Three different PPAP grades were defined based on the clinical impact: (1) grade postoperative hyperamylasemia, biochemical changes only; (2) grade B, mild or moderate complications; and (3) grade C, severe life-threatening complications.

DISCUSSIONS

The present definition and grading scale of PPAP, based on biochemical, radiologic, and clinical criteria, are instrumental for a better understanding of PPAP and the spectrum of postoperative complications related to this emerging entity. The current terminology will serve as a reference point for standard assessment and lend itself to developing specific treatments and prevention strategies.

摘要

目的

国际胰腺外科研究组（ISGPS）旨在为胰瘘（PPAP）制定一个普遍接受的定义，用于标准化报告和结果比较。

背景

PPAP是部分胰腺切除术后一种日益被认识到的并发症，但其发生率、临床影响，甚至其存在情况都存在差异，因为缺乏国际公认的共识定义和分级系统。

方法

ISGPS在对证据进行审查后，经过一系列讨论，并于2020年4月至2021年5月进行多次修订，与成员们共同制定了PPAP的共识定义和分级。

结果

我们将PPAP定义为胰腺部分切除术后头3天内开始的胰腺残端急性炎症状态。诊断需要（1）术后持续血清高淀粉酶血症（POH）在术后至少头48小时内高于机构正常上限，（2）伴有临床相关特征，以及（3）与PPAP一致的影像学改变。根据临床影响定义了三种不同的PPAP分级：（1）A级，术后高淀粉酶血症，仅有生化改变；（2）B级，轻度或中度并发症；（3）C级，严重危及生命的并发症。