术后高淀粉酶血症（POH）是胰体尾切除术后胰瘘发生及严重程度的早期预测指标：一项欧洲多中心研究的结果

Postoperative Hyperamylasemia (POH) Is an Early Predictor of Pancreatic Fistula Occurrence and Severity After Distal Pancreatectomy: Results from a European Multicentric Study.

作者信息

Perri Giampaolo, Romandini Elisa, Marchegiani Giovanni, Ghorbani Poya, Sahakyan Musheg, Holmberg Marcus, Cattelani Alice, Fretland Åsmund, Montorsi Roberto, Rodrigues Isabella D, Kleive Dyre, Bannone Elisa, Edwin Bjørn, Gilg Stefan, Labori Knut Jørgen, Sparrelid Ernesto, Salvia Roberto

机构信息

Department of General and Pancreatic Surgery, Verona University Hospital, Verona, Italy.

Department of Clinical Science, Intervention and Technology, Division of Surgery, Karolinska University Hospital, Stockholm, Sweden.

出版信息

Ann Surg. 2025 Aug 1;282(2):291-298. doi: 10.1097/SLA.0000000000006222. Epub 2024 Feb 2.

DOI:10.1097/SLA.0000000000006222

PMID:38305035

Abstract

OBJECTIVES

The aim of this international multicentric study is to characterize postoperative hyperamylasemia (POH) after distal pancreatectomy (DP), with particular focus on its relationship with postoperative pancreatic fistula (POPF) occurrence and severity.

BACKGROUND

The clinical relevance of POH after DP and its relationship with the occurrence and severity of POPF have not been explored yet.

METHODS

All patients undergoing DP for any indication between 2015 and 2021 at 3 European referral centers for pancreatic surgery were retrospectively analyzed. Drain fluid amylase, C-reactive protein, and serum amylase were examined from postoperative day (POD) 1 to 3. Biochemical leak, POPF, POH, and postpancreatectomy hemorrhage were defined and graded according to ISGPS definitions.

RESULTS

In total, 1192 patients were included. Overall rates of POH and POPF were 18% (n= 210) and 29% (n= 344), respectively. The presence of drain fluid amylase ≥2000 U/L on POD 1 (OR=2.11, 95% CI: 1.68-2.86), C-reactive protein ≥200 mg/L on POD 3 (OR=2.19, 95% CI: 1.68-2.86), and POH (OR=1.58, 95% CI: 1.14-2.19) were all independent early predictors of POPF (all P <0.01). The presence of POH almost doubled the rate of POPF (43% vs 26%, P <0.001), and higher POPF severity presented also higher POH rates (no POPF=12%; biochemical leak=19%; B POPF=24%; C POPF=52%). Among patients developing POPF, patients with POH had higher rates of postpancreatectomy hemorrhage (22% vs 9%, P =0.001), sepsis (24% vs 13%; P =0.011), reoperation (21% vs 8%; P < 0.01), and mortality (3% vs 0.3%; P =0.025).

CONCLUSIONS

The occurrence of POH is an early predictor of POPF and its severity after DP. The diagnosis of POH might define patients at higher risk for a complicated course, targeting them for prevention/mitigation strategies against pancreas-specific complications.

摘要

目的

本国际多中心研究旨在描述胰体尾切除术（DP）后术后高淀粉酶血症（POH）的特征，尤其关注其与术后胰瘘（POPF）发生及严重程度的关系。

背景

DP术后POH的临床相关性及其与POPF发生和严重程度的关系尚未得到探讨。

方法

回顾性分析2015年至2021年期间在3家欧洲胰腺手术转诊中心因任何适应症接受DP的所有患者。术后第1天至第3天检测引流液淀粉酶、C反应蛋白和血清淀粉酶。根据国际胰腺外科研究组（ISGPS）的定义对生化漏、POPF、POH和胰切除术后出血进行定义和分级。

结果

共纳入1192例患者。POH和POPF的总体发生率分别为18%（n = 210）和29%（n = 344）。术后第1天引流液淀粉酶≥2000 U/L（OR = 2.11，95%CI：1.68 - 2.86）、术后第3天C反应蛋白≥200 mg/L（OR = 2.19，95%CI：1.68 - 2.86）以及POH（OR = 1.58，95%CI：1.14 - 2.19）均为POPF的独立早期预测因素（所有P < 0.01）。POH的存在使POPF的发生率几乎翻倍（43%对26%，P < 0.001），且POPF严重程度越高，POH发生率也越高（无POPF = 12%；生化漏 = 19%；B级POPF = 24%；C级POPF = 52%）。在发生POPF的患者中，有POH的患者胰切除术后出血发生率更高（22%对9%，P = 0.001）、脓毒症发生率更高（24%对13%；P = 0.011）、再次手术率更高（21%对8%；P < 0.01）以及死亡率更高（3%对0.3%；P = 0.025）。