Predictive value of postoperative serum lipase level for postoperative pancreatic fistula after pancreaticoduodenectomy  

作　　者：Bing-Jun Tang Si-Jia Li Peng-Fei Wang Can-Hong Xiang Jian-Ping Zeng Jun Shi Jia-Hong Dong Xue-Dong Wang 

机构地区：[1]Hepatopancreatobiliary Center,Beijing Tsinghua Changgung Hospital,School of Clinical Medicine,Tsinghua University,Beijing 102218,China [2]Department of Gastrointestinal Surgery,Beijing Tsinghua Changgung Hospital,School of Clinical Medicine,Tsinghua University,Beijing 102218,China [3]Key Laboratory of Digital Intelligence Hepatology(Ministry of Education),School of Clinical Medicine,Tsinghua University,Beijing 102218,China [4]Research Unit of Precision Hepatobiliary Surgery Paradigm,Chinese Academy of Medical Sciences,Beijing 102218,China

出　　处：《Hepatobiliary & Pancreatic Diseases International》2025年第2期197-205,共9页国际肝胆胰疾病杂志(英文版)

基　　金：supported by grants from the Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences(2019-I2M-5–056);the National Natural Science Foundation of China(81930119,82090050,and 82090053)。

摘　　要：Background:The prediction of postoperative pancreatic fistula(POPF)is important.This study aimed to investigate the role of postoperative serum lipase level in predicting POPF.Methods:Data from 234 consecutive patients who underwent pancreaticoduodenectomy(PD)were collected.The predictive values of serum amylase and serum lipase during postoperative days(PODs)1 to 3 for POPF were compared.Subgroup analyses were performed to determine the prognostic value of different levels and durations of elevated serum lipase.Results:Fifty-six patients developed POPF.The POPF group exhibited increased levels of serum amylase and lipase from PODs 1 to 3(all P<0.001).Compared with serum amylase,serum lipase has greater predictive value for POPF.Specifically,serum lipase had the highest area under the receiver operating characteristic curve(AUC)at POD 1(0.791).Body mass index>24 kg/m2[odds ratio(OR)=2.431,95%confidence interval(CI):1.094–5.404,P=0.029],soft pancreatic texture(OR=3.189,95%CI:1.263–8.056,P=0.014),serum lipase>60 U/L at POD 1(OR=5.135,95%CI:1.257–20.982,P=0.023),and C-reactive protein>167 mg/dL at POD 3(OR=3.607,95%CI:1.431–9.090,P=0.007)were identified as independent risk factors for POPF.Patients with serum lipase≤60 U/L at POD 1(n=104)exhibited lower rates of POPF(3.8%vs.40.0%,P<0.001)and severe complications(Clavien-Dindo≥IIIa)(4.8%vs.25.4%,P<0.001)than those with serum lipase>60 U/L at POD 1.Moreover,no additional elevation or duration of serum lipase offered any further prognostic value.Conclusions:Postoperative serum lipase outperformed serum amylase in the prediction of POPF,and patients with normal serum lipase level at POD 1 had favorable outcomes.A sustained increase in the serum lipase level offers no additional prognostic value.

关 键 词：PANCREATICODUODENECTOMY Postoperative pancreatic fistula LIPASE MORBIDITY 

分 类 号：R657.5[医药卫生—外科学]