BACKGROUND The available prediction models for clinically relevant postoperative pancreatic fistula (CR-POPF) do not incorporate both preoperative and intraoperative variables. AIM To construct a new risk scoring syst...BACKGROUND The available prediction models for clinically relevant postoperative pancreatic fistula (CR-POPF) do not incorporate both preoperative and intraoperative variables. AIM To construct a new risk scoring system for CR-POPF that includes both preoperative and intraoperative factors. METHODS This was a retrospective study of patients who underwent pancreaticoduodenectomy (PD) or pylorus-preserving PD (PPPD) between January 2011 and December 2016 at the First Affiliated Hospital of Soochow University. Patients were divided into a study (01/2011 to 12/2014) or validation (01/2015 to 12/2016) group according to the time of admission. POPF severity was classified into three grades: Biochemical leak (grade A) and CR-POPF (grades B and C). Logistic regression was used to create a predictive scoring system. RESULTS Preoperative serum albumin ≥ 35 g/L [P = 0.032, odds ratio (OR)= 0.92, 95% confidence interval (CI): 0.85-0.99], hard pancreatic texture (P = 0.004, OR = 0.25, 95%CI: 0.10-0.64), pancreatic duct diameter ≥ 3 mm (P = 0.029, OR = 0.50, 95%CI: 0.27-0.93), and intraoperative blood loss ≥ 500 mL (P = 0.006, OR = 1.002, 95%CI:1.001-1.003) were independently associated with CR-POPF. We established a 10-point risk scoring system to predict CR-POPF. The area under the curve was 0.821 (95%CI: 0.736-0.905) and the cut-off value was 3.5. Including drain amylase levels improved the predictive power of the model. CONCLUSION This study established a 10-point scoring system to predict CR-POPF after PD/PPPD using preoperative and intraoperative parameters. Ultimately, this system could be used to distinguish between high- and low-risk populations in order to facilitate timely interventions after PD.展开更多
BACKGROUND: Postoperative pancreatic fistula(POPF) remains common and morbid after pancreaticoduodenectomy(PD). A major advance in the study of POPF is the fistula risk score(FRS).METHODS: We analyzed 48 consecutive p...BACKGROUND: Postoperative pancreatic fistula(POPF) remains common and morbid after pancreaticoduodenectomy(PD). A major advance in the study of POPF is the fistula risk score(FRS).METHODS: We analyzed 48 consecutive patients undergoing PD. The 'Colonial Wig' pancreaticojejunostomy(CWPJ) technique was used in the last 22 PDs, we compared 22 CWPJ to 26 conventional PDs. RESULTS: Postoperative morbidity was 49%(27% Clavien grade >2). The median length of hospital stay was 11 days. In the first 26 PDs, the PJ was performed according to standard techniques and the clinically relevant POPF(CR-POPF) rate was 15%, similar to the FRS-predicted rate(14%). In the next 22 PJs, the CWPJ was employed. Although the FRS-predicted rates were similar in these two groups(14% vs 13%), the CRPOPF rate in the CWPJ group was 0(P=0.052).CONCLUSION: Early experience with the CWPJ is encouraging, and this anastomosis may be a safe and effective way to lower POPF rates.展开更多
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...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。展开更多
基金Supported by the Key Research and Development of Jiangsu Province of China,No.BE2016673the Jiangsu Province"333"Project,No.BRA2018392+2 种基金the Jiangsu Provincial Medical Youth Talent,No.QNRC2016734Six Talent Peaks Project in Jiangsu Province,No.WSW-059the Project of Suzhou People’s Livelihood Science and Technology,No.SS201632
文摘BACKGROUND The available prediction models for clinically relevant postoperative pancreatic fistula (CR-POPF) do not incorporate both preoperative and intraoperative variables. AIM To construct a new risk scoring system for CR-POPF that includes both preoperative and intraoperative factors. METHODS This was a retrospective study of patients who underwent pancreaticoduodenectomy (PD) or pylorus-preserving PD (PPPD) between January 2011 and December 2016 at the First Affiliated Hospital of Soochow University. Patients were divided into a study (01/2011 to 12/2014) or validation (01/2015 to 12/2016) group according to the time of admission. POPF severity was classified into three grades: Biochemical leak (grade A) and CR-POPF (grades B and C). Logistic regression was used to create a predictive scoring system. RESULTS Preoperative serum albumin ≥ 35 g/L [P = 0.032, odds ratio (OR)= 0.92, 95% confidence interval (CI): 0.85-0.99], hard pancreatic texture (P = 0.004, OR = 0.25, 95%CI: 0.10-0.64), pancreatic duct diameter ≥ 3 mm (P = 0.029, OR = 0.50, 95%CI: 0.27-0.93), and intraoperative blood loss ≥ 500 mL (P = 0.006, OR = 1.002, 95%CI:1.001-1.003) were independently associated with CR-POPF. We established a 10-point risk scoring system to predict CR-POPF. The area under the curve was 0.821 (95%CI: 0.736-0.905) and the cut-off value was 3.5. Including drain amylase levels improved the predictive power of the model. CONCLUSION This study established a 10-point scoring system to predict CR-POPF after PD/PPPD using preoperative and intraoperative parameters. Ultimately, this system could be used to distinguish between high- and low-risk populations in order to facilitate timely interventions after PD.
文摘BACKGROUND: Postoperative pancreatic fistula(POPF) remains common and morbid after pancreaticoduodenectomy(PD). A major advance in the study of POPF is the fistula risk score(FRS).METHODS: We analyzed 48 consecutive patients undergoing PD. The 'Colonial Wig' pancreaticojejunostomy(CWPJ) technique was used in the last 22 PDs, we compared 22 CWPJ to 26 conventional PDs. RESULTS: Postoperative morbidity was 49%(27% Clavien grade >2). The median length of hospital stay was 11 days. In the first 26 PDs, the PJ was performed according to standard techniques and the clinically relevant POPF(CR-POPF) rate was 15%, similar to the FRS-predicted rate(14%). In the next 22 PJs, the CWPJ was employed. Although the FRS-predicted rates were similar in these two groups(14% vs 13%), the CRPOPF rate in the CWPJ group was 0(P=0.052).CONCLUSION: Early experience with the CWPJ is encouraging, and this anastomosis may be a safe and effective way to lower POPF rates.
文摘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。
