Shasheendra Yanagandula, Ahmed Zeeshan, Shetty Mahesh G, Hazarathaiah Nadendla, Rebala Pradeep, Rao Guduru V
Surgical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, IND.
Cureus. 2024 Jan 30;16(1):e53257. doi: 10.7759/cureus.53257. eCollection 2024 Jan.
Background In this study, we aimed to determine the association between postoperative hyperamylasemia (POH) and clinically relevant postoperative pancreatic fistula (CR-POPF) after pancreatoduodenectomy (PD). Methodology A prospective observational study of 140 consecutive PDs between March 2020 and March 2022 was conducted. POH was defined as an elevation in serum pancreatic amylase levels above the institutional upper limit of normal on postoperative day (POD) 1 (>100 U/L). CR-POPF was defined as the International Study Group of Pancreatic Surgery Grade B or C POPF. The primary outcome was the rate of CR-POPF in the study population. The trial was prospectively registered with Clinicaltrials.gov (NCT04514198). Results In our study, 93 (66.42%) patients had POH (serum amylase >100 U/L). CR-POPF developed in 48 (34.28%) patients: 40 type B and 8 type C. CR-POPF rate was 43.01% (40/93) in patients with POH compared to 17.02% (8/47) in patients without POH (p = 0.0022). Patients with POH had a mean serum amylase of 422.7 ± 358.21 U/L on POD1 compared to 47.2 ± 20.19 U/L in those without POH (p < 0.001). Serum amylase >100 U/L on POD1 was strongly associated with developing CR-POPF (odds ratio = 3.71; 95% confidence interval = 1.31-10.37) on logistic regression, with a sensitivity and specificity of 83.3% and 42.4%, respectively. Blood loss >350 mL, pancreatic duct size <3 mm, and elevated POD1 serum amylase >100 U/L were predictive of CR-POPF on multivariate analysis (p < 0.001). Conclusions An elevated serum amylase on POD1 may help identify patients at risk for developing POPF following PD.
背景 在本研究中，我们旨在确定胰十二指肠切除术（PD）后术后高淀粉酶血症（POH）与临床相关的术后胰瘘（CR-POPF）之间的关联。
方法 对2020年3月至2022年3月期间连续进行的140例PD手术进行了前瞻性观察研究。POH定义为术后第1天（POD 1）血清胰淀粉酶水平高于机构正常上限（>100 U/L）。CR-POPF定义为国际胰腺手术研究组B级或C级胰瘘。主要结局是研究人群中CR-POPF的发生率。该试验已在Clinicaltrials.gov（NCT04514198）上进行了前瞻性注册。
结果 在我们的研究中，93例（66.42%）患者出现POH（血清淀粉酶>100 U/L）。48例（34.28%）患者发生CR-POPF：40例B型和8例C型。POH患者的CR-POPF发生率为43.01%（40/93），而无POH患者为17.02%（8/47）（p = 0.0022）。POH患者在POD1时的平均血清淀粉酶为422.7±358.21 U/L，而无POH患者为47.2±20.19 U/L（p < 0.001）。POD1时血清淀粉酶>100 U/L与发生CR-POPF密切相关（比值比 = 3.71；95%置信区间 = 1.31-10.37），逻辑回归分析显示其敏感性和特异性分别为83.3%和42.4%。多因素分析显示，失血>350 mL、胰管直径<3 mm以及POD1时血清淀粉酶升高>100 U/L可预测CR-POPF（p < 0.001）。
结论 POD1时血清淀粉酶升高可能有助于识别PD术后发生胰瘘风险的患者。
