Joshi Kunal, Abradelo Manuel, Bartlett David Christopher, Chatzizacharias Nikolaos, Dasari Bobby Venkata, Isaac John, Marudanayagam Ravi, Mirza Darius, Roberts Keith, Sutcliffe Robert Peter
Liver Unit, Queen Elizabeth Hospital, Birmingham, United Kingdom.
Ann Hepatobiliary Pancreat Surg. 2023 May 31;27(2):189-194. doi: 10.14701/ahbps.22-083. Epub 2023 Feb 15.
BACKGROUNDS/AIMS: Postoperative pancreatic fistula (POPF) after pancreaticoduodenectomy (PD) is a source of major morbidity and mortality. Early diagnosis and treatment of POPF is mandatory to improve patient outcomes and clinical risk scores may be ombined with postoperative drain fluid amylase (DFA) values to stratify patients. The aim of this pilot study was to etermine if intraoperative fluid amylase (IFA) values correlate with DFA1 and POPF.
In patients undergoing PD from February to November 2020, intraoperative samples of intra-abdominal fluid adjacent to the pancreatic anastomosis were taken and sent for fluid amylase measurement prior to abdominal closure. Data regarding patient demographics, postoperative DFA values, complications, and mortality were prospectively collected.
Data were obtained for 52 patients with a median alternative Fistula Risk Score (aFRS) of 9.9. Postoperative complications occurred in 20 (38.5%) patients (five Clavien grade ≥ 3). There were eight POPFs and two patients died (pneumonia/sepsis). There was a significant correlation between IFA and DFA1 (R = 0.713; < 0.001) and DFA3 ( < 0.001), and the median IFA was higher in patients with POPF than patients without (1,232.5 vs. 122; = 0.0003). IFA > 260 U/L predicted POPF with sensitivity, specificity, positive and negative predictive values of 88.0%, 75.0%, 39.0%, and 97.0%, respectively. The incidence of POPF was 43.0% in high-risk (high aFRS/IFA) and 0% in lowrisk patients (low aFRS/IFA).
IFA correlated with POPF and may be a useful adjunct to clinical risk scores to stratify patients during PD. Larger, prospective studies are needed to determine whether IFA has clinical utility.
背景/目的：胰十二指肠切除术（PD）后发生的术后胰瘘（POPF）是导致严重发病和死亡的原因。早期诊断和治疗POPF对于改善患者预后至关重要，临床风险评分可与术后引流液淀粉酶（DFA）值相结合以对患者进行分层。本初步研究的目的是确定术中液体淀粉酶（IFA）值是否与DFA1及POPF相关。
在2020年2月至11月接受PD的患者中，在关闭腹腔前采集胰腺吻合口附近的腹腔内液体的术中样本，并送去进行液体淀粉酶测量。前瞻性收集有关患者人口统计学、术后DFA值、并发症和死亡率的数据。
获得了52例患者的数据，中位替代瘘风险评分（aFRS）为9.9。20例（38.5%）患者发生术后并发症（5例Clavien分级≥3级）。有8例POPF，2例患者死亡（肺炎/脓毒症）。IFA与DFA1（R = 0.713；P < 0.001）和DFA3（P < 0.001）之间存在显著相关性，发生POPF的患者的中位IFA高于未发生POPF的患者（1232.5对122；P = 0.0003）。IFA>260 U/L预测POPF的敏感性、特异性、阳性和阴性预测值分别为88.0%、75.0%、39.0%和97.0%。高风险（高aFRS/IFA）患者中POPF的发生率为43.0%，低风险患者（低aFRS/IFA）中为0%。
IFA与POPF相关，可能是临床风险评分的有用辅助手段，用于在PD期间对患者进行分层。需要开展更大规模的前瞻性研究来确定IFA是否具有临床实用性。
