术中胰腺残端淀粉酶测定对术后胰瘘的预测作用  

Role of intraoperative amylase from the pancreatic stump in predicting the presence of pancreatic fistula

作　　者：王伟珅[1] 钱浩 林捷威 翁原弛 张俊[1] 王建承[1] Wang Weishen;Qian Hao;Lin Jiewei;Weng Yuanchi;Zhang Jun;Wang Jiancheng(Department of General Surgery,Ruijin Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200025,China)

机构地区：[1]上海交通大学医学院附属瑞金医院普通外科,上海200025

出　　处：《中华胰腺病杂志》2019年第4期261-264,共4页Chinese Journal of Pancreatology

摘　　要：目的探讨术中胰腺残端的淀粉酶测定值对术后胰瘘的预测价值。方法收集2017年6月至2018年7月上海瑞金医院收治的26例行胰体尾切除术及胰中段切除术患者的临床资料,对术中胰腺残端的淀粉酶水平及围手术期可能与胰瘘发生有关的临床因素进行分析。应用受试者工作特征(ROC)曲线评估术中胰腺残端淀粉酶水平预测患者术后发生胰瘘的诊断效能,计算敏感度和特异度。结果26例患者中19例行胰体尾切除术,7例行胰中段切除术。术后6例未发生胰瘘,9例(34.6%,9/26)发生A级胰瘘(生化漏),11例(42.3%,11/26)发生B级胰瘘,无C级胰瘘。单因素分析结果显示,临床相关性胰瘘组(B级胰瘘+C级胰瘘)术中胰腺残端淀粉酶水平高于非临床相关性胰瘘组(无胰瘘+A级胰瘘,7971.82±4387.98比1589.20±1405.00,P=0.001)。ROC曲线分析结果显示,术中胰腺残端淀粉酶水平预测患者术后发生临床相关性胰瘘的曲线下面积为0.921,95%可信区间为0.807~1.000,最佳截断值为3 622 U/L,敏感度和特异度分别为90.9%和86.7%。结论术中胰腺残端淀粉酶水平可以作为预测术后胰瘘发生的一项临床指标。Objective To investigate the predictive role of the intraoperative amylase (IOA) from pancreatic stump for postoperative pancreatic fistula. Methods The clinical data of 26 patients who received distal pancreatectomy (DP) and central pancreatectomy (CP) in the Shanghai Ruijin Hospital from June 2017 to July 2018 were retrospectively analyzed. IOA and peri-operative potential clinical factors associated with pancreatic fistula were analyzed. Receiver operating characteristics (ROC) curve was drawn to evaluate the diagnostic efficacy of IOA from pancreatic stump in predicting postoperative pancreatic fistula, and the sensitivity and specificity were calculated. Results Of 26 patients, 19 patients underwent DP and 7 patients underwent CP. 9 patients (34.6%, 9/26)had class A pancreatic fistula (biochemical leak) and 11 patients (42.3%, 11/26) had class B pancreatic fistula after surgery, and no class C pancreatic fistula occurred. Univariate analysis showed that IOA from pancreatic stump in clinically relevant pancreatic fistula group was higher than that in clinically irrelevant pancreatic fistula group(7971.82±4387.98 vs1589.20±1405.00, P=0.001). Area under the curve (AUC) of IOA in predicting the development of clinically relevant pancreatic fistula after surgery was 0.921 and 95% confidential interval was 0.807-1.000. The optimal cut-off value was 3 622 U/L , and the sensitivity and specificity were 90.9% and 86.7%. Conclusions IOA from pancreatic stump could serve as a clinical indicator for predicting the occurrence of postoperative pancreatic fistula.

关 键 词：胰腺切除术 胰腺瘘 术中淀粉酶 预测 

分 类 号：R657.5[医药卫生—外科学]