POSSUM评分系统预测胰十二指肠切除术手术风险的价值

The POSSUM scoring system for risks assessment in pancreatoduodenectomy

目的探讨POSSUM评分系统在预测胰十二指肠切除术（PD）手术风险中的价值。方法采用POSSUM评分系统（含12项生理学指标和6项手术学指标）对2005年1月至2007年12月在四川大学华西医院肝胆胰外科接受PD手术的265例患者的资料前瞻性地进行评分，根据公式计算出预期术后并发症和术后病死率的发生情况；按Clavien术后并发症诊断标准和国内参考标准分别统计分析术后实际并发症的发生情况，并与预期并发症发生情况进行比较。结果265例患者的生理学评分为12—24分，平均15分；手术学评分为14—24分，平均17分；POSSUM评分值为0．24～0．88分，预期平均并发症发生率为43．8％，发生例数为116例；实际观察有105例术后发生不同程度的并发症，实际并发症发生率为39．6％，与预测数比较差异无统计学意义（P〉0．05）。进一步的分层分析发现，POSSUM评分为0．4～0．8分时预测最为准确；POSSUM评分系统在预测术后总的病死率时价值不大，但对于POSSUM评分I〉0．5分患者的病死率预测仍有意义。结论POSSUM评分系统能较好地预测PD的手术风险，对于PD手术及术后处理决策有指导意义。

Objective To explore the value of the POSSUM scoring system in predicting postoperative morbidity and mortality of pancreatoduodenectomy （PD）. Methods Two hundreds and sixty- five consecutive PDs were performed between January 2005 and December 2007. POSSUM scores which relied on 12 physiologic and 6 operative variables were prospectively calculated for each case. Expected morbidity and mortality were estimated based on POSSUM scores and were compared with observed morbidity ,which were diagnosed according to the Clavien complication scheme and domestic reference criteria respectively, and mortality. Results Physiologic scores of 265 cases ranged from 12 to 24, the mean was 15. Operative scores ranged from 14 to 24, the mean was 17. The overall POSSUM scores ranged from 0. 24 to 0. 88. Average expected morbidity was 43.8% ,expected cases were 116. Observed morbidity rate was 39. 6% （105/265）. The expected and observed morbidities and cases had no significantly differences. All patients were classified to 1 of 4 strata based on their individual POSSUM scores and subsequent risk of morbidity. Predictive value was the highest when scores ranged from 0. 4 to 0. 8. POSSUM exhibited less predictive value for mortality, but if POSSUM was more than 0. 5, it was useful for mortality predicting. Conclusions POSSUM scoring system has high value for predicting the risk of morbidity in PD and can be helpful in guiding surgery and postoperative management decisions.