Drainage fluid and serum amylase levels accurately predict development of postoperative pancreatic fistula.
Drainage fluid and serum amylase levels accurately predict development of postoperative pancreatic fistula.
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DOI：
10.3748/wjg.v23.i34.6357
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发表时间：
2017-09-14
影响因子：
4.3
通讯作者：
Wang GY
中科院分区：
文献类型：
--
作者：
Jin S;Shi XJ;Wang SY;Zhang P;Lv GY;Du XH;Wang GY
探讨预测胰腺十二指肠切除术(PD)术后胰瘘(POPF)的潜在生物标志物。我们前瞻性地招募了83名患者参加这项研究。所有患者均于2011年6月至2015年4月在吉林大学白求恩第一医院肝胆胰科接受肝胆胰科手术。分析包括人口统计学变量、临床特征、胰腺质地、手术方式、组织病理学结果、血清、胰腺/胃引流液中的白细胞计数、淀粉酶和胆碱水平以及腹水中胆碱和淀粉酶的水平。评估这些参数与术后并发症的潜在相关性，如POPF、急性胰腺炎、出血、胃排空延迟和胆瘘。83例患者中有28例(33.7%)发生POPF。根据胰瘘标准，POPF严重程度A级8例(28%)，B级16例(58%)，C级4例(14%)。单因素和多因素Logistic回归分析显示，术后第1天(POD)腹水淀粉酶水平和术后第4天血清淀粉酶水平与POPF显著相关(P<；0.05)。在受试者工作特征曲线分析中，腹水淀粉酶水平为2365.5 U/L与78.6%的敏感性和80%的特异性相关[曲线下面积：0.844；P=0.009]。以血清淀粉酶水平为44.2U/L作为诊断临界值，其敏感度为78.6%，特异度为70.9%(AUC：0.784；P=0.05)。POD1期腹水淀粉酶水平和POD4期血清淀粉酶水平是与POPF发生相关的新生物标志物。
To investigate potential biomarkers for predicting postoperative pancreatic fistula (POPF) after pancreaticoduodenectomy (PD). We prospectively recruited 83 patients to this study. All patients underwent PD (Child’s procedure) at the Division of Hepatobiliary and Pancreas Surgery at the First Bethune Hospital of Jilin University between June 2011 and April 2015. Data pertaining to demographic variables, clinical characteristics, texture of pancreas, surgical approach, histopathological results, white blood cell count, amylase and choline levels in the serum, pancreatic/gastric drainage fluid, and choline and amylase levels in abdominal drainage fluid were included in the analysis. Potential correlations between these parameters and postoperative complications such as, POPF, acute pancreatitis, hemorrhage, delayed gastric emptying, and biliary fistula, were assessed. Twenty-eight out of the 83 (33.7%) patients developed POPF. The severity of POPF was classified as Grade A in 8 (28%) patients, grade B in 16 (58%), and grade C in 4 (14%), according to the pancreatic fistula criteria. On univariate and multivariate logistic regression analyses, higher amylase level in the abdominal drainage fluid on postoperative day (POD)1 and higher serum amylase levels on POD4 showed a significant correlation with POPF (P < 0.05). On receiver operating characteristic curve analysis, amylase cut-off level of 2365.5 U/L in the abdominal drainage fluid was associated with a 78.6% sensitivity and 80% specificity [area under the curve (AUC): 0.844; P = 0.009]. A cut-off serum amylase level of 44.2 U/L was associated with a 78.6% sensitivity and 70.9% specificity (AUC: 0.784; P = 0.05). Amylase level in the abdominal drainage fluid on POD1 and serum amylase level on POD4 represent novel biomarkers associated with POPF development.
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