Centro Universitário Faculdade de Medicina do ABC, Department of Gastrointestinal Surgery - Santo André (SP), Brazil.
Arq Bras Cir Dig. 2023 May 19;36:e1728. doi: 10.1590/0102-672020230002e1728. eCollection 2023.
The high morbidity and mortality rates of pancreaticoduodenectomy are mainly associated with pancreaticojejunal anastomosis, the most fragile and susceptible to complications such as clinically relevant postoperative pancreatic fistula.
The alternative fistula risk score and the first postoperative day drain fluid amylase are predictors of the occurrence of clinically relevant postoperative pancreatic fistula. No consensus has been reached on which of the scores is a better predictor; moreover, their combined predictive power remains unclear. To the best of our knowledge, this association had not yet been studied.
This study assessed the predictive effect of alternative fistula risk score and/or drain fluid amylase on clinically relevant postoperative pancreatic fistula in a retrospective cohort of 58 patients following pancreaticoduodenectomy. The Shapiro-Wilk and Mann-Whitney tests were applied for assessing the distribution of the samples and for comparing the medians, respectively. The receiver operating characteristics curve and the confusion matrix were used to analyze the predictive models.
The alternative fistula risk score values were not statistically different between patients in the clinically relevant postoperative pancreatic fistula and non- clinically relevant postoperative pancreatic fistula groups (Mann-Whitney U test 59.5, p=0.12). The drain fluid amylase values were statistically different between clinically relevant postoperative pancreatic fistula and non- clinically relevant postoperative pancreatic fistula groups (Mann-Whitney U test 27, p=0.004). The alternative fistula risk score and drain fluid amylase were independently less predictive for clinically relevant postoperative pancreatic fistula, compared to combined alternative fistula risk score + drain fluid amylase.
The combined model involving alternative fistula risk score >20% + drain fluid amylase=5,000 U/L was the most effective predictor of clinically relevant postoperative pancreatic fistula occurrence following pancreaticoduodenectomy.
胰十二指肠切除术的高发病率和死亡率主要与胰肠吻合术有关，胰肠吻合术是最脆弱的，容易发生术后胰腺瘘等并发症。
替代瘘风险评分和术后第 1 天引流液淀粉酶是预测临床相关术后胰腺瘘发生的指标。哪种评分是更好的预测指标尚未达成共识；此外，它们联合预测能力仍不清楚。据我们所知，这种关联尚未被研究过。
本研究评估了替代瘘风险评分和/或引流液淀粉酶对胰十二指肠切除术后 58 例患者临床相关术后胰腺瘘的预测作用。Shapiro-Wilk 和 Mann-Whitney 检验分别用于评估样本的分布和中位数的比较。受试者工作特征曲线和混淆矩阵用于分析预测模型。
临床相关术后胰腺瘘和非临床相关术后胰腺瘘患者的替代瘘风险评分值无统计学差异（Mann-Whitney U 检验 59.5，p=0.12）。临床相关术后胰腺瘘和非临床相关术后胰腺瘘患者的引流液淀粉酶值有统计学差异（Mann-Whitney U 检验 27，p=0.004）。与联合替代瘘风险评分+引流液淀粉酶相比，替代瘘风险评分和引流液淀粉酶对临床相关术后胰腺瘘的预测作用独立降低。
涉及替代瘘风险评分>20%+引流液淀粉酶=5,000 U/L 的联合模型是预测胰十二指肠切除术后临床相关术后胰腺瘘发生的最有效指标。
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