Mahmmud Lana Othman, Bartusevicius Vilhelmas, Norberg Åke, Ghorbani Poya, Grip Jonathan
Dept. of Clinical Science, Intervention and Technology, CLINTEC, Karolinska Institute, Stockholm, Sweden.
Function Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm Sweden.
Surg Pract Sci. 2025 Jul 24;22:100298. doi: 10.1016/j.sipas.2025.100298. eCollection 2025 Sep.
Lactate is often elevated following major pancreatic surgery but the clinical relevance of this it not known.
A retrospective study including 491 consecutive patients undergoing major pancreatic surgery. Lactate upon arrival to post anaesthesia unit (L), the morning following surgery (L) and the highest value within those two time points (L) were examined. The primary outcome was postoperative complications (Clavien-Dindo IIIa-V) and the secondary outcomes were surgery specific complications and hospital length of stay.
Median lactate values were: L01.7 mmol/L (IQR: 1.2 -2.6), LPOD11.3 mmol/L (IQR: 0.9 -1.9) and L 2.3 mmol/L (IQR 1.7 -3.1). There were no differences in lactate values at any measuring point between those developing complications and those that didn´t. AUROC analysis (0.531-0.581) and Youden´s index (0.08-0.17) indicated poor diagnostic performance. L > 2.65 mmol/L was associated with Odds ratio 2.05 (1.34 -3.14) for developing postoperative complications. Plasma lactate was higher following total pancreatectomy compared to partial resection at all three time points.
Plasma lactate elevation in common following pancreatic surgery; however, this is of limited clinical use to predict complications. The relatively higher lactate following total pancreatectomy might be due to hormonal deficits inherent to this procedure.
在接受大型胰腺手术后，乳酸水平常常会升高，但这种情况的临床相关性尚不清楚。
一项回顾性研究，纳入了491例连续接受大型胰腺手术的患者。检测患者到达麻醉后护理单元时的乳酸水平（L0）、术后早晨的乳酸水平（L1）以及这两个时间点内的最高乳酸值（Lmax）。主要结局是术后并发症（Clavien-Dindo IIIa-V级），次要结局是手术特异性并发症和住院时间。
乳酸水平的中位数分别为：L0 1.7 mmol/L（四分位间距：1.2 - 2.6），L1 1.3 mmol/L（四分位间距：0.9 - 1.9），Lmax 2.3 mmol/L（四分位间距1.7 - 3.1）。发生并发症的患者与未发生并发症的患者在任何测量点的乳酸值均无差异。受试者工作特征曲线下面积分析（0.531 - 0.581）和尤登指数（0.08 - 0.17）表明诊断性能较差。Lmax > 2.65 mmol/L与发生术后并发症的比值比为2.05（1.34 - 3.14）相关。在所有三个时间点，全胰切除术后的血浆乳酸水平均高于部分切除术后。
胰腺手术后血浆乳酸水平普遍升高；然而，这在预测并发症方面的临床应用有限。全胰切除术后相对较高的乳酸水平可能是由于该手术固有的激素缺乏所致。
