胰十二指肠切除术后胰外分泌功能与术后胰瘘的病理评估之间的关系。

Association Between Preoperative Pancreatic Exocrine Function and Pathological Evaluation With Postoperative Pancreatic Fistulas Following Pancreaticoduodenectomy.

机构信息

Department of Hepato-Biliary-Pancreatic Surgery and Transplantation, Ehime University, School of Medicine, Ehime, Japan;

Department of Hepato-Biliary-Pancreatic Surgery and Transplantation, Ehime University, School of Medicine, Ehime, Japan.

出版信息

Anticancer Res. 2023 Aug;43(8):3563-3569. doi: 10.21873/anticanres.16534.

DOI:10.21873/anticanres.16534

PMID:37500133

Abstract

BACKGROUND/AIM: Postoperative pancreatic fistula (POPF) may cause severe complications. In this study, risk factors for postoperative pancreatic fluid leakage after pancreaticoduodenectomy (PD) were investigated, with a particular focus on preoperative pancreatic exocrine function and pathological evaluations of the resected pancreas.

PATIENTS AND METHODS

A total of 67 patients underwent the N-benzoyl-L-tyrosyl-para-aminobenzoic acid (BT-PABA) test and PD in our department between June 2003 and March 2018. The endpoint was the development of POPF. Patients' clinical characteristics, preoperative test results, surgery-related parameters, and pathological evaluations of the resected samples were investigated. Preoperative pancreatic exocrine function was evaluated by the BT-PABA test, and the proportion of residual acinar tissue and the fibrosis rate of the resected pancreatic tissue were assessed.

RESULTS

17 (25.4%) patients with Grade B and C POPF were compared with 50 patients without POPF. On univariate analysis, pancreatic carcinoma (p=0.028), BT-PABA test results higher than 66.3% (p=0.030), and main pancreatic duct (MPD) diameter lower than 5.0 mm (p=0.006) were identified as risk factors for postoperative pancreatic fluid leakage. On multivariate analysis, pancreatic carcinoma (p=0.008), BT-PABA test results higher than 66.3% (p=0.036), MPD diameter lower than 5.0mm (p=0.029) were significant risk factors. BT-PABA test results have a moderate correlation with both the proportion of pancreatic acinar tissue (r=0.421, p=0.028) and the pancreatic fibrosis rate (r=-0.443, p=0.021).

CONCLUSION

The preoperative BT-PABA test results higher than 66.3% were an independent risk factor for POPF. This suggests that the development of POPF may be attenuated by diminished exocrine function with poor pancreatic fluid flow and the progression of fibrosis.

摘要

背景/目的：术后胰瘘（POPF）可能导致严重并发症。本研究旨在探讨胰十二指肠切除术（PD）后胰液漏的术后危险因素，特别关注术前胰腺外分泌功能和切除胰腺的病理评估。

患者与方法

2003 年 6 月至 2018 年 3 月期间，共有 67 例患者在我科接受 N-苯甲酰-L-酪氨酸-对氨基苯甲酸（BT-PABA）试验和 PD。终点为 POPF 的发生。研究患者的临床特征、术前检查结果、手术相关参数和切除标本的病理评估。通过 BT-PABA 试验评估术前胰腺外分泌功能，评估残留腺组织的比例和切除胰腺组织的纤维化率。

结果

将 17 例（25.4%）B 级和 C 级 POPF 患者与 50 例无 POPF 患者进行比较。单因素分析显示，胰腺癌（p=0.028）、BT-PABA 试验结果大于 66.3%（p=0.030）和主胰管（MPD）直径小于 5.0mm（p=0.006）为术后胰液漏的危险因素。多因素分析显示，胰腺癌（p=0.008）、BT-PABA 试验结果大于 66.3%（p=0.036）和 MPD 直径小于 5.0mm（p=0.029）为显著危险因素。BT-PABA 试验结果与胰腺腺泡组织比例（r=0.421，p=0.028）和胰腺纤维化率（r=-0.443，p=0.021）均具有中度相关性。