The Combination of Pancreas Texture and Postoperative Serum Amylase in Predicting Pancreatic Fistula Risk
The Combination of Pancreas Texture and Postoperative Serum Amylase in Predicting Pancreatic Fistula Risk
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胰腺质地与术后血清淀粉酶联合预测胰瘘风险
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发表时间：
2018
期刊：
影响因子：
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通讯作者：
H. Lavu
中科院分区：
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作者：
Crystal B Chen;Neal S. McCall;M. Pucci;B. Leiby;Nooreen S. Dabbish;J. Winter;C. Yeo;H. Lavu
胰瘘是胰管切除术后最重要的并发症之一。最近，研究表明，PD后血清高淀粉酶血症（HA）可能是一个危险因素。在这项研究中，我们评估胰腺质地和术后血清淀粉酶水平在确定PF风险中的关系。这项回顾性队列研究评价了2009年至2014年在托马斯杰斐逊大学接受PD的所有患者。术后0 ~ 5天血清淀粉酶水平最高。卡方分析和比值比（OR）评估胰腺质地，血清淀粉酶水平和PF的发展之间的关系。从524例连续患者的数据进行了分析。血清淀粉酶阈值为165 IU/L时，受试者工作特征曲线分析的准确性最高（灵敏度，0.70;特异性，0.72）。B级或C级PF在HA患者中更常见（20比3%; P < 0.001）。HA与PD相关并发症的发生率增加相关。在多变量分析中，术后早期血清HA比胰管直径≤3 mm（OR，2.97; P = 0.01）或胰腺质地（OR，1.87; P = 0.05）更能预测PF风险（OR，4.87; P <0.001）。结论：在POD 0或POD 1时HA的存在比单独的软胰腺质地或小胰管尺寸更具有预测性。
Postoperative pancreatic fistula (PF) remains one of the most significant complications after pancreaticoduodenectomy (PD). Recently, studies have suggested that post-PD serum hyper-amylasemia (HA) may be a risk factor. In this study, we evaluate the relationship of pancreas texture and post-operative serum amylase levels in determining PF risk. This retrospective cohort study evaluated all patients who underwent PD at Thomas Jefferson University from 2009 to 2014. The highest postoperative serum amylase level from postoperative day (POD) 0 to POD 5 was obtained. Chi-square analyses and odds ratio (OR) evaluated the relationship between pancreas texture, serum amylase level, and the development of PF. Data from 524 consecutive patients were analyzed. Serum amylase threshold value of 165 IU/L yielded greatest accuracy from the receiver operating characteristic curve analysis (Sensitivity, 0.70; specificity, 0.72). Grade B or C PF were more common among HA patients (20 vs 3%; P < 0.001). HA was associated with increased rates of PD-associated complications. On multivariable analysis, early postoperative serum HA was more predictive of PF risk (OR, 4.87; P < 0.001) than either pancreatic duct size ≤3 mm (OR, 2.97; P = 0.01) or pancreas texture (OR,1.87; P = 0.05). Conclusion: The presence of HA on POD 0 or POD 1 is more predictive than soft pancreas texture or small pancreas duct size alone.