Department of Hepato-Biliary-Pancreatic and Breast Surgery, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, Japan.
Department of Hepato-Biliary-Pancreatic and Breast Surgery, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, Japan.
Pancreatology. 2022 Jun;22(5):651-655. doi: 10.1016/j.pan.2022.04.002. Epub 2022 Apr 6.
/Objectives: Postoperative pancreatic fistula (POPF) is a serious complication after pancreaticoduodenectomy (PD). Thus, identification of the risk factors for POPF is urgently needed. In this study, we aimed to identify whether arterial lactate (LCT) levels following PD might be a marker of the potential risk of POPF.
Between September 2009 and December 2020, 151 patients who underwent elective PD were retrospectively enrolled. Patient characteristics, perioperative clinicopathological variables, postoperative blood biochemistry data were analyzed in univariable and multivariable analyses. Pancreatic fistula of Grade B and C was considered as POPF.
Patients were divided into the POPF group (n = 33, 21.9%) and non-POPF group (n = 118, 78.1%). Higher body mass index (p = 0.017), increased estimated blood loss (p = 0.047), soft textured pancreas (p = 0.007), smaller main pancreatic duct (p = 0.016), higher LCT levels (p < 0.001), higher aspartate aminotransferase levels (p = 0.023) and higher procalcitonin levels (p = 0.024) were significantly associated with POPF. Receiver operating characteristic curve analysis revealed that 2.1 mmol/L was the optimal cut-off value of LCT (sensitivity = 78.8%, specificity = 61.2%) for predicting POPF occurrence. Univariate and multivariate analyses confirmed that an LCT of ≥2.1 mmol/L was independently associated with the risk of POPF following PD (odds ratio = 6.78, 95% confidence interval = 2.22-20.74; p = 0.001).
Higher LCT is a predictive marker for POPF following PD.
/目的：胰十二指肠切除术（PD）后发生胰瘘（POPF）是一种严重的并发症。因此，迫切需要确定 POPF 的危险因素。在这项研究中，我们旨在确定 PD 后动脉血乳酸（LCT）水平是否可能是潜在 POPF 风险的标志物。
回顾性纳入 2009 年 9 月至 2020 年 12 月期间接受择期 PD 的 151 例患者。对患者特征、围手术期临床病理变量和术后血液生化数据进行单变量和多变量分析。B 级和 C 级胰瘘被认为是 POPF。
患者分为 POPF 组（n=33，21.9%）和非 POPF 组（n=118，78.1%）。较高的体质指数（p=0.017）、增加的估计出血量（p=0.047）、软质地胰腺（p=0.007）、较小的主胰管（p=0.016）、较高的 LCT 水平（p<0.001）、较高的天冬氨酸转氨酶水平（p=0.023）和较高的降钙素原水平（p=0.024）与 POPF 显著相关。受试者工作特征曲线分析显示，2.1mmol/L 是 LCT 预测 POPF 发生的最佳截断值（灵敏度=78.8%，特异性=61.2%）。单变量和多变量分析均证实，LCT≥2.1mmol/L 与 PD 后发生 POPF 的风险独立相关（比值比=6.78，95%置信区间=2.22-20.74；p=0.001）。
较高的 LCT 是 PD 后发生 POPF 的预测标志物。
