胰瘘风险评分表联合术后第一日腹腔引流液淀粉酶预测胰十二指肠切除术后临床胰瘘

Combination of fistula risk score and drain fluid amylase on postoperative day one to predict clinically relevant postoperative pancreatic fistula following pancreaticoduodenectomy

目的探索联合应用胰瘘风险评分表(fistula risk score,FRS)和术后第一日腹腔引流液淀粉酶(drain fluid amylase on postoperative day 1,DFA1)预测胰十二指肠切除术(pancreaticoduodenectomy,PD)后临床胰瘘的条件,指导术后早期拔除腹腔引流管。方法回顾性分析陆军军医大学第一附属医院肝胆外科2013年1月至2015年10月收治的430例PD手术患者的临床资料,采用受试者操作特性(ROC)曲线验证FRS对术后临床胰瘘的预测价值,并在FRS中高分段组(3~10分)患者中进一步利用DFA1对术后临床胰瘘进行预测分析。结果430例患者中发生术后临床胰瘘56例(13.0%),FRS预测术后临床胰瘘的ROC曲线下面积为0.894(95%CI:0.861~0.921,P<0.001),单因素和多因素Logistic回归分析显示:FRS为术后临床胰瘘的独立影响因素(OR=2.933,95%CI:2.230~3.856,P<0.001)。将430例患者参考FRS分组后,低分段组(0~2分)患者无术后临床胰瘘发生;中高分段组(3~10分)患者中应用ROC曲线分析计算得出DFA1>653.9U/L预测术后临床胰瘘的敏感度、特异度、阳性预测值、阴性预测值分别为87.5%、63.8%、39.2%、95.0%。结论对于FRS≤2分、以及FRS≥3分且DFA1≤650 U/L的患者,PD术后可选择早期拔除腹腔引流管。

Objective To evaluate combining fistula risk score(FRS)with drain fluid amylase on postoperative day 1(DFA1)in predicting clinically relevant postoperative pancreatic fistula(CR-POPF)following pancreaticoduodenectomy(PD).Methods The clinical data of 430 patients who underwent PD in the First Afiliated Hospital of Amy Medical University from Jan 2013 to Oct 2015 was retrospectively analyzed,receiver operating characteristic curve(ROC curve)was used to test whether the FRS predicts the CR-POPF,and DFA1 was employed to predict the CR-POPF in the moderate/high subgroup patients(FRS 3-10).Results Fifty six patients(13.0%)had CR-POPF,the ROC curve for FRS predicting CR-POPF was formed with area under curve 0.894(95%CI:0.861-0.921,P<0.001),the results from univariate and multivariate logistic regression analysis showed that FRS was independent risk factor associated with CR-POPF(OR=2.933,95%CI:2.230-3.856,P<0.001).After dividing 430 patients into 2 groups by FRS category,there was no CR-POPF in negligible/low subgroup patients(FRS 0-2),and FRS>2 predicted CR-POPF with negative predictive value 100%;in moderate/high subgroup patients(FRS 3-10),ROC curve worked out DFA1>653.9 U/L predicting CR-POPF well with senstivity,specificity,positive and negative predictive value of 87.5%,63.8%,39.2%,95.0%,respectively.Conclusion For patients with FRS≤2,and FRS≥3 accompanying DFA1≤650 U/L,early removal of intra-abdominal drains after PD is safe.