Early Drain Removal-The Middle Ground Between the Drain Versus No Drain Debate in Patients Undergoing Pancreaticoduodenectomy A Prospective Validation Study
Early Drain Removal-The Middle Ground Between the Drain Versus No Drain Debate in Patients Undergoing Pancreaticoduodenectomy A Prospective Validation Study
复制标题
DOI：
10.1097/sla.0000000000001038
复制
发表时间：
2015-08-01
影响因子：
9
通讯作者：
Fernandez-del Castillo, Carlos
中科院分区：
文献类型：
--
作者：
Fong, Zhi Ven;Correa-Gallego, Camilo;Fernandez-del Castillo, Carlos
目的：对胰十二指肠切除术 (PD) 术后第一天 (POD 1) 引流淀粉酶水平和胰瘘 (PF) 进行公正的评估。背景：最近的证据表明，PD 中放弃引流是不安全的。早期引流淀粉酶水平已被提议作为 PD 后 PF 的预测因子，从而可以选择早期移除引流管的患者。方法：每日引流淀粉酶水平与接受 PD 的 2 个独立队列患者中 PF 的发展相关：训练队列（n = 126；2008 年）和验证队列（n = 369；2009-2012 年）。结果：POD 1 引流淀粉酶水平具有最高的预测能力（一致性指数：0.911）训练队列中的 PF。 612 U/L 或更高的淀粉酶水平显示出最佳的准确性 (86%)、敏感性 (93%) 和特异性 (79%)。因此，使用 600 U/L 的截止值。在验证队列中，229 例（62.1%）患者的 POD 1 引流淀粉酶水平低于 600 U/L，仅 2 例（0.9%）发生 PF；而 POD 1 引流淀粉酶水平为 600 U/L 或更高的患者 (n = 140) PF 率为 31.4%（比值比 [OR] = 52，P < 0.0001）。在多变量分析中，低于 600 U/L（OR = 0.0192，P < 0.0001）的 POD 1 引流淀粉酶水平比胰腺质地（OR = 0.193，P = 0.002）和导管直径（OR = 0.861，P = 0.835）更能预测不存在 PF。结论：PD 后，发生 PF 的风险较低如果 POD 1 排出淀粉酶水平低于 600 U/L，则低于 1%。我们建议，在该组中，超过 60% 的患者应在 POD 1 时拔除引流管。
Objective: To perform an unbiased assessment of first postoperative day (POD 1) drain amylase level and pancreatic fistula (PF) after pancreaticoduodenectomy (PD).Background: Recent evidence demonstrated that drain abandonment in PD is unsafe. Early drain amylase levels have been proposed as predictors of PF after PD, allowing for selection of patients for early drain removal.Methods: Daily drain amylase levels were correlated with the development of PF in 2 independent cohorts of patients undergoing PD: training cohort (n = 126; year 2008) and validation cohort (n = 369; years 2009-2012).Results: POD 1 drain amylase level had the highest predictive ability (concordance index: 0.911) for PF in the training cohort. An amylase level of 612 U/L or higher showed the best accuracy (86%), sensitivity (93%), and specificity (79%). Thus, a cutoff value of 600 U/L was utilized. In the validation cohort, 229 (62.1%) patients had a POD 1 drain amylase level of lower than 600 U/L, and PF developed in only 2 (0.9%) cases; whereas in patients with POD 1 drain amylase level of 600 U/L or higher (n = 140) the PF rate was 31.4% (odds ratio [OR] = 52, P < 0.0001). On multivariate analysis, POD 1 drain amylase level of lower than 600 U/L (OR = 0.0192, P < 0.0001) was a stronger predictor of the absence of PF than pancreatic gland texture (OR = 0.193, P = 0.002) and duct diameter (OR = 0.861, P = 0.835).Conclusions: After PD, the risk of PF is less than 1% if POD 1 drain amylase level is lower than 600 U/L. We propose that in this group, which comprise more than 60% of patients, drains should be removed on POD 1.