术前CT指标预测胰十二指肠切除术后胰瘘风险的可行性分析  

Feasibility analysis of predicting the risk of pancreatic fistula after pancreatoduodenectomy by preoperative CT

作　　者：余淼[1] 王亚东[1] 薛焕洲[1] 申权[1] 徐建[1] 张晓[1] 贾江坤[1] 贾萌[1] Yu Miao Wang Yadong Xue Huanzhou Shen Quan Xu Jian Zhang xiao Jia Jiangkun Jia Meng(Department of Hepatobiliary Surgery, People＇s Hospital of Zhengzhou University, Zhengzhou 450003, Chin)

机构地区：[1]郑州大学人民医院肝胆胰腺外科,450003

出　　处：《中华医学杂志》2017年第30期2362-2365,共4页National Medical Journal of China

摘　　要：目的 通过胰十二指肠切除术（PD）患者术前的计算机断层扫描（ CT）资料,探讨能预测术后胰瘘（POPF）的有效指标.方法 回顾性分析郑州大学人民医院2010年6月至2017年1月行PD患者的CT图像资料,研究胰腺指数、胰管宽度、胰腺CT值、胰脾CT值比、胰腺厚度等13个变量指标,确定各指标与POPF的相关性,绘制受试者工作曲线（ROC）并计算曲线下面积（AUC）进行评价.对具有最大AUC的指标设计不同切割点值,计算约登指数等指标,找出具有最大预测效能的临界值.结果 共154例PD患者纳入研究范围,27例（17.5％）发生了POPF.变量指标中7个与POPF显著关联,其中胰腺指数具有ROC曲线下具有最大面积（AUC：0.865,P〈0.001）;胰管宽度（AUC：0.834,P〈0.001）同样具有较高的预测价值;胰腺厚度、胰脾CT值比率、腹壁脂肪厚度、胰腺CT值、胰腺腹主动脉CT比率与POPF同样相关.胰腺指数切割点界定在0.15时,敏感度为0.83,特异度为0.86,约登指数为0.69,准确度为0.88,预测效能最高.脐周腹围、脾脏CT值等6个指标与POPF无相关性.结论 对术前患者CT指标进行分析可预测PD术后POPF的风险,通过评估发现胰腺指数具有最大预测效能,同时胰管宽度,胰脾密度比等指标与POPF相关.Objective To study the preoperative computed tomography （CT） data of patients with pancreaticoduodenectomy （PD） and to explore the effective of predicting the risk of postoperative pancreatic fistula （POPF）. Methods CT images of patients with PD were analyzed retrospectively from June 2010 to January 2017 in Zhengzhou University of People′s Hospital. The pancreas index, pancreatic duct width, pancreas CT value, pancreas-spleen CT value, and pancreas thickness were collected. The relationship between the indicators and the POPF was determined, and the receiver operation characteristic （ROC） curve was calculated and the area under the curve （AUC） was evaluated. The maximum predictive performance of the critical value was determined by using the different cut-off values to calculate the Youden index and other indicators.Results A total of 154 patients with PD were involved in the study and 27 （17.5%） had POPF. Seven indicators were significantly associated with POPF. The pancreas index had the largest AUC （AUC：0.865, P〈0.001） and pancreatic duct width （AUC：0.834, P〈0.001） also had a higher predictive value. The pancreatic duct （P〈0.001） was significantly associated with POPF. Pancreas thickness, pancreas and spleen CT ratio, abdominal wall fat thickness, pancreas CT value, pancreatic abdominal aorta CT ratio and POPF were also related. Using 0.15 as the cut-off value, the sensitivity, specificity, Jordan index, and accuracy of pancreatic index were 83%, 86%, 0.69, and 0.88 respectively, with the highest performance prediction. Abdominal circumference, spleen CT value and other six indicators had no correlation with POPF.Conclusion Analysis of preoperative CT indicators of patients can predict the risk of POPF in patients after PD. The pancreas index has the greatest predictive efficacy, while pancreatic duct width, pancreatic spleen density ratio and other indicators also associated with POPF.

关 键 词：计算机断层扫描 胰瘘 胰十二指肠切除术 

分 类 号：R657.5[医药卫生—外科学]