Department of General Surgery, Pancreatic Disease Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Institute of Translational Medicine, Shanghai Jiao Tong University, Shanghai, China.
J Gastroenterol Hepatol. 2023 Dec;38(12):2228-2237. doi: 10.1111/jgh.16364. Epub 2023 Oct 3.
Several indicators are recognized in the development of clinically relevant postoperative pancreatic fistula (CR-POPF) after pancreaticoduodenectomy (PD). However, drain fluid volume (DFV) remains poorly studied. We aimed to discover the predictive effects of DFV and guide clinical management.
We retrospectively reviewed the clinical data of patients that received PD between January 2015 and December 2019 in a high-volume center. DFV was analyzed as a potential risk factor and postoperative short-term outcomes as well as drain removal time were compared stratified by different DFV levels. Receiver operating characteristic curves and area under curves (AUC) were compared for DFV alone and DFV combined with drain fluid amylase (DFA). Subgroup analysis of DFV stratified by DFA evaluated the predictability of CR-POPF.
CR-POPF occurred in 19.7% of 841 patients. Hypertension, postoperative day 3 (POD3) DFA ≥ 300 U/L, and POD3 DFV ≥ 30 mL were independent risk factors, while pancreatic main duct diameter ≥ 3 mm was a protective factor. POD3 DFV ≥ 30 mL increased the overall occurrences of CR-POPF and major complications (P = 0.017; P = 0.029). POD3 DFV alone presented a low predictive value (AUC 0.602), while POD3 DFV combined with DFA had a high predictive value (AUC 0.759) for CR-POPF. Subgroup analysis showed that the combination of POD3 DFV ≥ 30 mL and DFA ≥ 300 U/L led to higher incidences of CR-POPF (P = 0.003).
CR-POPF is common after PD, and high DFV combined with DFA may predict its occurrence and facilitate appropriate management.
胰十二指肠切除术（PD）后发生临床相关的胰瘘（CR-POPF）有几个公认的指标。然而，引流液量（DFV）的研究仍较少。我们旨在发现 DFV 的预测作用，并指导临床管理。
我们回顾性分析了 2015 年 1 月至 2019 年 12 月在一家大容量中心接受 PD 的患者的临床资料。分析 DFV 作为潜在风险因素，并比较不同 DFV 水平分层后的术后短期结果和引流管拔除时间。比较 DFV 与 DFV 联合引流液淀粉酶（DFA）的单独使用的受试者工作特征曲线和曲线下面积（AUC）。对 DFA 分层的 DFV 进行亚组分析，评估 CR-POPF 的预测能力。
841 例患者中，CR-POPF 的发生率为 19.7%。高血压、术后第 3 天（POD3）DFA≥300U/L 和 POD3 DFV≥30mL 是独立的危险因素，而主胰管直径≥3mm 是保护因素。POD3 DFV≥30mL 增加了 CR-POPF 和主要并发症的总发生率（P=0.017；P=0.029）。POD3 DFV 单独预测 CR-POPF 的价值较低（AUC 0.602），而 POD3 DFV 联合 DFA 对 CR-POPF 具有较高的预测价值（AUC 0.759）。亚组分析显示，POD3 DFV≥30mL 和 DFA≥300U/L 的联合导致 CR-POPF 的发生率更高（P=0.003）。
PD 后 CR-POPF 很常见，高 DFV 联合 DFA 可能预测其发生，并有助于适当的管理。
