Chen Haoda, Wang Weishen, Fu Ningzhen, Xia Wentao, Li Hongzhe, Ji Yuchen, Zhong Jingyu, Wang Jiancheng, Deng Xiaxing, Xu Zhiwei, Weng Yuanchi, Shen Baiyong
Department of General Surgery, Pancreatic Disease Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Department of Imaging, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Ann Surg. 2024 Mar 19. doi: 10.1097/SLA.0000000000006277.
This study aimed to investigate the clinical significance and risk factors of postoperative pancreatic fistula (POPF) after post-pancreatectomy acute pancreatitis (PPAP) in patients who underwent pancreaticoduodenectomy (PD).
PPAP has been recognized as a critical factor in the pathophysiology of POPF after PD.
A total of 817 consecutive patients who underwent elective PD between January 2020 and June 2022 were included. PPAP and POPF were defined in accordance with the International Study Group for Pancreatic Surgery (ISGPS) definitions. Multivariate logistic analyses were performed to investigate the risk factors for POPF. Comparisons between PPAP-associated POPF and non-PPAP-associated POPF were made to further characterize this intriguing complication.
Overall, 159 (19.5%) patients developed POPF after PD, of which 73 (45.9%) occurred following PPAP, and the remaining 86 (54.1%) had non-PPAP-associated POPF. Patients with PPAP-associated POPF experienced significantly higher morbidity than patients without POPF. Multivariate analyses revealed distinct risk factors for each POPF type. For PPAP-associated POPF, independent risk factors included estimated blood loss >200 mL (OR 1.93), MPD ≤3 cm (OR 2.88), and soft pancreatic texture (OR 2.01), largely overlapping with FRS (Fistula Risk Score) elements. On the other hand, non-PPAP-associated POPF was associated with age >65 years (OR 1.95), male (OR 2.10), and MPD ≤3 cm (OR 2.57). Notably, among patients with PPAP, the incidence of POPF consistently hovered around 50% regardless of the FRS stratification.
PPAP-associated POPF presents as a distinct pathophysiology in the development of POPF after PD, potentially opening doors for future prevention strategies targeting the early postoperative period.
本研究旨在探讨接受胰十二指肠切除术（PD）的患者在胰十二指肠切除术后急性胰腺炎（PPAP）后发生术后胰瘘（POPF）的临床意义及危险因素。
PPAP已被认为是PD术后POPF病理生理学中的一个关键因素。
纳入2020年1月至2022年6月期间连续接受择期PD的817例患者。PPAP和POPF根据国际胰腺手术研究组（ISGPS）的定义进行定义。进行多因素逻辑分析以研究POPF的危险因素。对PPAP相关的POPF和非PPAP相关的POPF进行比较，以进一步描述这一有趣的并发症。
总体而言，159例（19.5%）患者在PD后发生POPF，其中73例（45.9%）在PPAP后发生，其余86例（54.1%）为非PPAP相关的POPF。PPAP相关的POPF患者的发病率显著高于无POPF的患者。多因素分析揭示了每种POPF类型的不同危险因素。对于PPAP相关的POPF，独立危险因素包括估计失血量>200 mL（OR 1.93）、主胰管（MPD）≤3 cm（OR 2.88）和胰腺质地柔软（OR 2.01），与胰瘘风险评分（FRS）要素有很大重叠。另一方面，非PPAP相关的POPF与年龄>65岁（OR 1.95）、男性（OR 2.10）和MPD≤3 cm（OR 2.57）相关。值得注意的是，在PPAP患者中，无论FRS分层如何，POPF的发生率始终徘徊在50%左右。
PPAP相关的POPF在PD术后POPF的发生中表现为一种独特的病理生理学，可能为未来针对术后早期的预防策略打开大门。
