目的: 探讨2017年中华医学会外科学分会胰腺外科学组的术后胰瘘预测评分的应用价值。方法: 本研究回顾性分析2014年1月至2016年12月我院249胰十二指肠切除术（pancreaticoduodenectomy, PD）及156例胰体尾切除术（distal pancreatectomy, DP）病人的资料。对可能与术后胰瘘发生有关的因素进行分析。根据预测评分中胰腺质地、肿瘤病理、胰管直径以及术中出血量4项指标进行评分。同时应用受试者工作特征（receiver operating characteristic, ROC）曲线分析此评分对病人术后胰瘘发生的灵敏度和特异度。结果: 249例PD病人中31例（12.4%）发生术后胰瘘。单因素分析结果显示,胰腺质地、肿瘤病理、胰管直径以及术中失血量是术后胰瘘发生的危险因素。ROC曲线结果显示,曲线下面积为0.894,P<0.001,95%CI：0.839~0.949。预测评分的灵敏度和特异度分别为83.9%和77.1%。156例DP病人中44例（28.2%）发生术后胰瘘。单因素分析结果显示,胰管直径以及术中出血量是术后胰瘘发生的危险因素。ROC曲线结果显示,曲线下面积为0.567,P=0.190,95%CI：0.467~0.668。预测评分的灵敏度和特异度分别为84.1%和27.7%。结论: 2017年中华医学会外科学分会胰腺外科学组术后胰瘘预测评分能准确地预测PD术后胰瘘的发生,但对DP术后胰瘘的预测没有作用。DP术后胰瘘的预测有待进一步研究。
Objective To investigate application of predictive scoring system for postoperative pancreatic fistula (POPF) issued by Division of Pancreatic Surgery Chinese Medical Association in 2017. Methods The data of 249 patients who received pancreaticoduodenectomy (PD) and 156 patients received distal pancreatectomy(DP) at our hospital from January 2014 to December 2016 were retrospectively studied. The risk factors associated with POPF were analyzed. Predictive scoring system was constructed using 4 factors including pancreatic texture, pathologic result of tumor, diameter of pancreatic duct and operative blood loss. Receiver operating characteristic (ROC) curve analysis was performed to evaluate sensitivity and specificity of predictive scoring system for prediction of POPF. Results A total of 31 (31/249,12.4%) patients undergoing PD had POPF. The results from univariate analysis showed that pancreatic texture, pathologic result of tumor, diameter of pancreatic duct and operative blood loss were risk factors of POPF of PD. ROC curve analysis showed area under the curve (AUC) of predictive scoring system 0.894 for PD (P<; 0.001, 95%CI：0.839-0.949) with sensitivity of 83.9% and specificity of 77.1%. There were 44 (44/156, 28.2%) patients undergoing DP with POPF. Diameter of pancreatic duct and operative blood loss were risk factor of POPF after DP from univariate analysis and AUC of predictive scoring system was 0.567 (P=0.190, 95%CI：0.467-0.668) with sensitivity of 84.1% and specificity of 27.7%. Conclusions The predictive scoring system POPF by Division of Pancreatic Surgery in 2017 could accurately predict the occurrence of POPF after PD, but not for POPF after DP, which needs further study.
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