Risk factors for biochemical leak progressing to grade B pancreatic fistula after pancreaticoduodenectomy early
10.3760/cma.j.issn.0529-5815.2019.09.003
- VernacularTitle: 胰十二指肠切除术后早期生化漏进展为B级胰瘘的预后因素分析
- Author:
Weicheng JI
1
;
Hao LIU
Author Information
1. Department of Hepatobiliary Surgery and Organ Transplantation, the First Hospital of China Medical University, Shenyang 110001, China
- Publication Type:Journal Article
- Keywords:
Pancreaticoduodenectomy;
Pancreatic fistula;
Biochemical leak;
Risk factors
- From:
Chinese Journal of Surgery
2019;57(9):654-659
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To analyze the risk factors for biochemical leak progressing to grade B pancreatic fistula after pancreaticoduodenectomy(PD) early.
Methods:Retrospective analysis was conducted in the whole clinical data of 190 patients who had incurred biochemical leak from November 2014 to April 2017 at the First Hospital of China Medical University.There were 112 males and 78 females, aging of (73±6) years(range:22 to 77 years).And all the potential factors for progressing from biochemical leak to grade B were analyzed with univariate and logistic regression multivariate model. These statistically significant preoperative indicators which enabled the plotting of the receiver operation characteristic(ROC) curves were selected for plotting the ROC curves, calculating the area under the curve(AUC) and evaluating the forecast values. With pertinence to indicators with the forecast values above the medium level, 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:Among the 190 cases of PD patients, there were 81 cases had incurred biochemical leak including 36 cases with no progression, 41 cases progressing to grade B and 4 cases progressing from grade B to grade C.Univariate analysis showed CT value of pancreatic body, acute pancreatitis preoperatively, and the platelet(PLT), prealbumin, ALT on postoperative 3-4 days were risk factors for progressing from biochemical leak to grade B. Multivariate analysis showed CT value, acute pancreatitis preoperatively, and the PLT on postoperative 3-4 days were independent risk factors. Postoperatively patients with biochemical leak got acute pancreatitis before surgery were more likely to progress to grade B as well as those with the lower CT value before surgery or the lower PLT at 3-4 days after surgery. The AUC of CT value was 0.734. Using 39.8 HU as CT value, the sensitivity, specificity and Youden index were 73.2%, 75.0% and 0.482, with the highest performance prediction.
Conclusion:The analysis of CT value of pancreatic body for standardized judgment of pancreas texture, the rational treatments of acute pancreatitis preoperatively and appropriate administration of patients with platelet-related drugs during perioperative period can respectively forecast and prevent progressing from biochemical leak to grade B.
