胰瘘风险评分系统在胰十二指肠切除术的应用价值

The clinicalvalue of pancreatic fistula risk scoring system in pancreaticoduodenectomy

目的探讨胰瘘风险评分系统(FRS)在胰十二指肠切除术(pancreaticoduodenectomy,PD)中的应用价值。方法回顾性分析2012年1月1日至2017年1月1日安徽医科大学附属省立医院胆胰外科收治的491例行PD患者完整围手术期临床资料,男288例,女203例。单因素和多因素logistic回归分析胰瘘的独立危险因素,并用受试者工作特征(ROC)曲线前瞻性分析98例PD患者FRS预测术后胰瘘发生率的价值。结果491例PD患者中共有90例(18.3%)患者发生胰瘘,其中A级胰瘘56例(11.4%),B级胰瘘26例(5.3%),C级胰瘘8例(1.6%)。单因素和多因素logistic回归分析发现男性、主胰管直径≤3 mm是影响PD术后胰瘘的独立危险因素。FRS评分无胰瘘风险组(0分)临床胰瘘发生率0,低胰瘘风险组(1~2分)临床胰瘘发生率为5.4%,中度胰瘘风险组(3~6分)临床胰瘘发生率为12.1%,高胰瘘风险组(7~10分)临床胰瘘发生率为60%。FRS前瞻性预测PD术后胰瘘的灵敏度为80%,特异度为70.5%,曲线下面积为0.852(95%CI:0.740~0.963)。结论FRS在前瞻性预测PD术后胰瘘有一定的临床推广价值,可以为外科医生早期术后进行胰瘘风险预测和干预。

Objective To explore the value of pancreatic fistula risk score(FRS)in pancreaticoduodenectomy(PD).Methods A total of 491 patients undergoing complete pancreaticoduodenectomy in the Department of Biliary Pancreatic Surgery,Affiliated Provincial Hospital of Anhui Medical University from January 1st,2012 to January 1st,2017 were included in this retrospective study.Among them,288 males and 203 females.Univariate and multivariate logistic regression analysis were used to determine the independent risk factors for pancreatic fistula.Receiver operating characteristic(ROC)curve was used to prospectively analyze the value of the FRS in predicting the incidence of postoperative pancreatic fistula in 90 PD patients.Results A total of 90 patients(18.3%)of 491 patients with PD developed pancreatic fistula,including 56 cases(11.4%)of grade A pancreatic fistula,26 cases(5.3%)of grade B pancreatic fistula,and 8 cases(1.6%)of grade C pancreatic fistula.Univariate and multivariate logistic regression analysis found that gender male,main pancreatic duct diameter≤3 mm were independent risk factor for pancreatic fistula after PD.FRS scores without pancreatic fistula risk group(0 points)clinical pancreatic fistula incidence rate 0,low pancreatic fistula risk group(1~2 points)clinical pancreatic fistula incidence rate 5.4%,moderate pancreatic risk group(3~6 points)The incidence of clinical pancreatic fistula was 12.1%,and the incidence of clinical pancreatic fistula was 60%in the high pancreatic risk group(7~10 points).The FRS system prospectively predicts the sensitivity of pancreatic fistula after surgery for PD was 80%,specificity was 70.5%,and the area under the curve was 0.852(95%CI:0.740~0.963).Conclusions The FRS has a certain clinical value in predicting pancreatic fistula after PD,which can predict and interfere with pancreatic fistula risk in early postoperative surgery.