Wu Shuai, Wu Hanxue, Xu Guiping, Zhao Yaling, Xue Feng, Dong Shunbin, Han Liang, Wang Zheng, Wu Zheng
Department of Hepatobiliary Surgery, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
Department of Physiology and Pathophysiology, School of Basic Medicine, Xi'an Jiaotong University, Xi'an, China.
Front Surg. 2022 Jul 4;9:916486. doi: 10.3389/fsurg.2022.916486. eCollection 2022.
The definition and grading system of post-pancreatectomy acute pancreatitis (PPAP) has recently been proposed by ISGPS. This study aimed to put this definition and classification into practice and investigate the potential risk factors and clinical impacts of PPAP.
Demographic and perioperative data of consecutive patients who underwent pancreaticoduodenectomy (PD) from January 2019 to July 2021 were collected and analyzed retrospectively. The diagnostic criteria of PPAP published by ISGPS, consisting of biochemical, radiologic, and clinical parameters, were adopted. The risk factors were analyzed by univariate and multivariate analyses.
A total of 298 patients were enrolled in this study, and the total incidence of PPAP was 52.4% (150 patients). Stratified by clinical impacts of PPAP, the incidences of grades B and C PPAP were 48.9% and 3.5%, respectively. PPAP after PD was significantly associated with pancreatic fistula and other unfavorable complications. Soft pancreatic texture (OR 3.0) and CRP ≥ 180 mg/L (OR 3.6) were the independent predictors of PPAP, AUC 0.613. Stratified by the grade of PPAP, soft pancreatic texture (OR 2.7) and CRP ≥ 180 mg/L (OR 3.4) were the independent predictors of grade B PPAP, and soft pancreatic texture (OR 19.3), operation duration >360 min (OR 13.8), and the pancreatic anastomosis by using conventional duct to mucosa methods (OR 10.4) were the independent predictors of grade C PPAP. PPAP complicated with pancreatic fistula significantly increased the severe complications and mortality compared to only PPAP occurrence.
PPAP was not an uncommon complication after PD and was associated with unfavorable clinical outcomes, especially since it was complicated with pancreatic fistula. Soft pancreatic texture and CRP ≥ 180 mg/L were the independent predictors of PPAP. Higher-volume multicenter and prospective studies are strongly needed.
国际胰腺外科研究小组（ISGPS）最近提出了胰十二指肠切除术后急性胰腺炎（PPAP）的定义和分级系统。本研究旨在将该定义和分类应用于临床实践，并探讨PPAP的潜在危险因素及临床影响。
回顾性收集并分析2019年1月至2021年7月期间连续接受胰十二指肠切除术（PD）患者的人口统计学和围手术期数据。采用ISGPS发布的PPAP诊断标准，该标准由生化、影像学和临床参数组成。通过单因素和多因素分析对危险因素进行分析。
本研究共纳入298例患者，PPAP的总发生率为52.4%（150例患者）。根据PPAP的临床影响分层，B级和C级PPAP的发生率分别为48.9%和3.5%。PD术后PPAP与胰瘘及其他不良并发症显著相关。胰腺质地柔软（比值比[OR] 3.0）和C反应蛋白（CRP）≥180 mg/L（OR 3.6）是PPAP的独立预测因素，曲线下面积（AUC）为0.613。根据PPAP分级分层，胰腺质地柔软（OR 2.7）和CRP≥180 mg/L（OR 3.4）是B级PPAP的独立预测因素，而胰腺质地柔软（OR 19.3）、手术时间>360分钟（OR 13.8）以及采用传统胰管对黏膜吻合方法（OR 10.4）是C级PPAP的独立预测因素。与仅发生PPAP相比，PPAP合并胰瘘显著增加了严重并发症和死亡率。
PPAP是PD术后并不少见的并发症，且与不良临床结局相关，尤其是合并胰瘘时。胰腺质地柔软和CRP≥180 mg/L是PPAP的独立预测因素。强烈需要开展更大规模的多中心前瞻性研究。
