胰瘘定义历史沿革与当前分级局限性和可能改进

Historical evolution of pancreatic fistula definition and current grading limitations and potential improvements

胰瘘是胰腺术后重要的并发症之一。2005年,国际胰瘘研究小组首次提出术后胰瘘标准定义和分级,这促进了胰腺外科相关研究的发展。2016年,国际胰腺外科研究小组(ISGPS)对术后胰瘘标准做出修改,整体更加强调临床相关性。术后胰瘘是评价吻合方式的重要指标之一,但是ISGPS 2016版胰瘘分级标准是一种以临床结局为导向的分级方式,它更多代表的是综合治疗效果,而不是单纯反映胰肠吻合的效果。使用这种分级方式来改进胰腺吻合方法不是特别准确,因此比较不同吻合方式需要一个真正能反映胰腺吻合质量的指标。本研究团队提议使用引流淀粉酶总量或高淀粉酶持续时间来研究胰腺消化道重建吻合方式来避免非重建方式等其他因素对术后胰瘘发生率和严重程度产生的影响,从而使吻合手术这一对术后胰瘘有重要影响的操作得到客观和有针对性的比较,进一步帮助临床医师找到胰腺消化道重建的理想方法。

Pancreatic fistula is one of the most important complications after pancreatic surgery.The International Study Group on Pancreatic Fistula proposed the definition and classification of postoperative pancreatic fistula(POPF)in 2005 firstly,which has promoted the development of pancreatic surgery research.And the International Study Group on Pancreatic Surgery modified the POPF standard in 2016 and paid more attention to clinical relevance.The POPF is often used to evaluate anastomotic methods.However,this grading version is based on clinical outcomes,which more represents the comprehensive treatment effect than reflects the quality of pancreaticojejunostomy.Using the current POPF grading criteria for the purpose of improving anastomosis methods is not very accurate,so an indicator that only reflects anastomosis'quality is needed for the comparison of various surgical methods.To avoid the influence of non-reconstruction elements on the incidence and degree of POPF,this research team prefer the total drainage fluid amylase(DFA)or the duration of high DFA.And in this way,the comparation among different anastomotic operations could be specific and objective,which further helps to find out an ideal method for pancreatic digestive tract reconstruction.