Department of Surgery, Saitama Red Cross Hospital, Japanese Red Cross Society, Saitama, Japan.
Department of General Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan.
Medicine (Baltimore). 2024 Oct 4;103(40):e39954. doi: 10.1097/MD.0000000000039954.
Despite the progress in surgical techniques and perioperative managements, the incidence of postoperative pancreatic fistula (POPF) after distal pancreatectomy (DP) remains high. Recently, pancreatic dissection using a linear stapler has been widely performed; however, risk factors influencing the occurrence of POPF after DP using a liner stapler is not fully understood. The purpose of this paper was to evaluate whether the relations between staple height and pancreatic thickness or main pancreatic duct (MPD) diameter influenced the incidence of POPF.
Patients who underwent DP without other organ resections between 2015 and 2022 were retrospectively reviewed. Compression Index (CI) was defined as staple height/pancreatic thickness, and Suturing Index (SI) was defined as staple height/ MPD diameter.
In 51 patients undergoing DP, 16 patients (31.4%) developed POPF. ROC analyses revealed that lower CI and higher SI significantly increased the incidence of POPF, and the cutoff values were 0.186 and 0.821, respectively. Univariate and multivariate analyses revealed that CI ≤ 0.186 and SI ≥ 0.821 were independent risk factors for POPF after DP. Moreover, the incidence of POPF in patients fulfilling both CI > 0.186 and SI < 0.821 was 5.9%, which was extremely lower than in those without fulfilling the criteria (44.1%), suggesting that this new criteria in combination with CI and SI was an excellent predictor of POPF.
It is possible that stapler cartridge selection using our new criteria in combination with CI and SI may reduce the incidence of POPF.
尽管在手术技术和围手术期管理方面取得了进步，但远端胰腺切除术（DP）后的术后胰腺瘘（POPF）发生率仍然很高。最近，使用线性吻合器进行胰腺解剖已广泛开展；然而，使用线性吻合器行 DP 后影响 POPF 发生的危险因素尚未完全了解。本文旨在评估钉高与胰腺厚度或主胰管（MPD）直径之间的关系是否影响 POPF 的发生率。
回顾性分析 2015 年至 2022 年间行 DP 而未行其他器官切除术的患者。定义压缩指数（CI）为钉高/胰腺厚度，缝合指数（SI）为钉高/MPD 直径。
在 51 例行 DP 的患者中，16 例（31.4%）发生 POPF。ROC 分析显示，较低的 CI 和较高的 SI 显著增加了 POPF 的发生率，截断值分别为 0.186 和 0.821。单因素和多因素分析表明，CI≤0.186 和 SI≥0.821 是 DP 后发生 POPF 的独立危险因素。此外，同时满足 CI＞0.186 和 SI＜0.821 的患者中 POPF 的发生率为 5.9%，明显低于不符合标准的患者（44.1%），提示该新标准联合 CI 和 SI 是 POPF 的良好预测指标。
使用我们的新标准联合 CI 和 SI 选择吻合器钉匣可能会降低 POPF 的发生率。
