Postoperative Serum Amylase Predicts Pancreatic Fistula Formation Following Pancreaticoduodenectomy
Postoperative Serum Amylase Predicts Pancreatic Fistula Formation Following Pancreaticoduodenectomy
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DOI：
10.1007/s11605-013-2293-3
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发表时间：
2014-02-01
影响因子：
3.2
通讯作者：
Norton, Jeffrey A.
中科院分区：
文献类型：
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作者：
Cloyd, Jordan M.;Kastenberg, Zachary J.;Norton, Jeffrey A.
早期识别胰十二指肠切除术（PD）后发生胰瘘（PF）风险的患者可能有助于预防或治疗策略，旨在降低其相关发病率。回顾性分析2006 - 2011年间176例连续PD患者术后第1天血清淀粉酶（POD1）与PD发展的关系，176例PD患者中有146例（83.0%）在POD1上记录了血清淀粉酶。27例（18.5%）患者发生了术后PF: 6例a型，19例B型，2例c型。PF患者的平均血清淀粉酶POD1为659 +/- 581，而无瘘患者的平均血清淀粉酶为246 +/- 368 （p < 0.001）。在logistic回归中，血清淀粉酶> 140 U/L与发生PF密切相关（OR, 5.48; 95% CI, 1.94-15.44）。术后血清淀粉酶> 140 U/L的敏感性为81.5%，特异性为55.5%。阳性预测值为29.3%，阴性预测值为93.0%。除其他预后因素外，血清中POD1的淀粉酶升高可用于帮助对PD后发生PF的风险进行分层。
Early identification of patients at risk for developing pancreatic fistula (PF) after pancreaticoduodenectomy (PD) may facilitate prevention or treatment strategies aimed at reducing its associated morbidity.A retrospective review of 176 consecutive PD performed between 2006 and 2011 was conducted in order to analyze the association between the serum amylase on postoperative day 1 (POD1) and the development of PF.Serum amylase was recorded on POD1 in 146 of 176 PD cases (83.0 %). Twenty-seven patients (18.5 %) developed a postoperative PF: 6 type A, 19 type B, and 2 type C. Patients with a PF had a mean serum amylase on POD1 of 659 +/- 581 compared to 246 +/- 368 in those without a fistula (p < 0.001). On logistic regression, a serum amylase > 140 U/L on POD1 was strongly associated with developing a PF (OR, 5.48; 95 % CI, 1.94-15.44). Sensitivity and specificity of a postoperative serum amylase > 140 U/L was 81.5 and 55.5 %, respectively. Positive and negative predictive values were 29.3 and 93.0 %, respectively.An elevated serum amylase on POD1 may be used, in addition to other prognostic factors, to help stratify risk for developing PF following PD.