Gajda Magdalena, Grudzińska Ewa, Szmigiel Paweł, Czopek Piotr, Rusinowski Cezary, Putowski Zbigniew, Mrowiec Sławomir
Department of Gastrointestinal Surgery, Medical University of Silesia, 40-752 Katowice, Poland.
Center for Intensive and Perioperative Care, Jagiellonian University, 31-007 Cracow, Poland.
Life (Basel). 2023 Dec 15;13(12):2344. doi: 10.3390/life13122344.
Clinically relevant acute postoperative pancreatitis (CR-PPAP) after pancreaticoduodenectomy (PD) is a complication that may lead to the development of local and systemic consequences. The study aimed to identify risk factors for CR-PPAP and assess the impact of CR-PPAP on the postoperative course after PD.
The study retrospectively analyzed data from 428 consecutive patients who underwent PD at a single center between January 2013 and December 2022. The presence of increased amylase activity in plasma, above the upper limit of normal 48 h after surgery, was checked. CR-PPAP was diagnosed when accompanied by disturbing radiological features and/or symptoms requiring treatment. We investigated the relationship between the occurrence of CR-PPAP and the development of postoperative complications after PD, and possible predictors of CR-PPAP.
The postoperative follow-up period was 90 days. Of the 428 patients, 18.2% (n = 78) had CR-PPAP. It was associated with increased rates of CR-POPF, delayed gastric emptying, occurrence of intra-abdominal collections, postoperative hemorrhage, peritonitis, and septic shock. Patients who developed CR-PPAP were more often reoperated (37.17% vs. 6.9%, < 0.0001)) and had increased postoperative mortality (14.1% vs. 5.74%, < 0.0001). Soft pancreatic parenchyma, intraoperative blood loss, small diameter of the pancreatic duct, and diagnosis of adenocarcinoma papillae Vateri were independent risk factors for CR-PPAP and showed the best performance in predicting CR-PPAP.
CR-PPAP is associated with an increased incidence of postoperative complications after PD, worse treatment outcomes, and an increased risk of reoperation and mortality. Pancreatic consistency, intraoperative blood loss, width of the duct of Wirsung, and histopathological diagnosis can be used to assess the risk of CR-PPAP. Amylase activity 48 h after surgery > 161 U/L is highly specific in the diagnosis of CR-PPAP.
胰十二指肠切除术（PD）后具有临床相关性的急性术后胰腺炎（CR-PPAP）是一种可能导致局部和全身后果的并发症。本研究旨在确定CR-PPAP的危险因素，并评估CR-PPAP对PD术后病程的影响。
本研究回顾性分析了2013年1月至2022年12月期间在单一中心接受PD的428例连续患者的数据。检查术后48小时血浆淀粉酶活性是否升高，超过正常上限。当伴有令人不安的放射学特征和/或需要治疗的症状时，诊断为CR-PPAP。我们调查了CR-PPAP的发生与PD术后并发症的发展之间的关系，以及CR-PPAP的可能预测因素。
术后随访期为90天。在428例患者中，18.2%（n = 78）发生CR-PPAP。它与CR-POPF、胃排空延迟、腹腔内积液、术后出血、腹膜炎和感染性休克的发生率增加有关。发生CR-PPAP的患者更常接受再次手术（37.17%对6.9%，<0.0001），术后死亡率增加（14.1%对5.74%，<0.0001）。胰腺实质柔软、术中失血、胰管直径小和 Vateri 乳头腺癌的诊断是CR-PPAP的独立危险因素，在预测CR-PPAP方面表现最佳。
CR-PPAP与PD术后并发症发生率增加、治疗效果较差以及再次手术和死亡风险增加有关。胰腺质地、术中失血、Wirsung管宽度和组织病理学诊断可用于评估CR-PPAP的风险。术后48小时淀粉酶活性>161 U/L对CR-PPAP的诊断具有高度特异性。
