术后第1天引流液中淀粉酶含量在预测胰瘘中的价值
| 作者: |
1成冬冬,
1刘宁,
2吴照东
1 山东省肥城矿业中心医院 普通外科，山东 泰安 271600 2 泰山医学院附属医院 普通外科一病区，山东 泰安 271000 |
| 通讯: |
吴照东
Email: sddoctor8611@126.com |
| DOI: | 10.3978/.10.3978/j.issn.1005-6947.2016.09.014 |
摘要
目的：探讨术后第1天引流液中淀粉酶含量（DFA1）在预测胰瘘（PF）中的价值。方法：收集泰山医学院附属医院及肥城矿业中心医院自2011年2月―2016年2月行胰腺切除的患者资料，选择其中有DFA1资料的患者，用受试者工作特征（ROC）曲线分析DFA1预测PF的敏感性、特异性、阳性预测值（PPV）及阴性预测值（NPV），并分析PF的危险因素。结果：共125例行胰腺切除术患者中67例（55例胰十二指肠切除术和12例胰体尾切除术）有DFA1资料。此67例中发生PF 15例（22.39%），其中A级7例（10.45%），B级6例（8.96%），C级2例（2.99%）。ROC曲线分析发现DFA1对PF有明显的预测作用（P<0.05），当截点值为342 U/L时，其敏感性、特异性、PPV、NPV分别为100%、80.8%、60.0%、100.0%。单因素分析显示，DFA1、胰管直径≤3 mm及胰腺质地软为PF的危险因素（均P<0.05），Logistic回归分析表明，DFA1为PF的独立危险因素（P<0.05）。结论：DFA1为PF的独立因素，对PF具有较好的预测价值，当患者DFA1>340 U/L时应积极预防PF的发生。
关键词：
胰腺切除术
淀粉酶类
胰腺瘘
Value of drain fluid amylase level obtained on the first postoperative day in prediction of pancreatic fistula
CorrespondingAuthor:WU Zhaodong Email: sddoctor8611@126.com
Abstract
Objective: To investigate the value of drain fluid amylase level obtained on the first postoperative day (DFA1) in predicting pancreatic fistula (PF). Methods: The clinical data of all patients undergoing pancreatic resection from February 2011 to February 2016 in the Affiliated Hospital of Taishan Medical College and FeichengKuangye Central Hospital were reviewed, and those with DFA1 data were selected. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of DFA1 for predicting PF were analyzed by receiver operating characteristic (ROC) curve, and the risk factors for PF were also determined. Results: A total of 125 patients underwent pancreatic resection and 67 cases (55 cases undergoing pancreaticoduodenectomy and 12 cases undergoing distal pancreatectomy) of them had DFA1 data. Of the 67 patients, PF occurred in 15 cases, which was classified as grade A in 7 cases (10.45%), grade B in 6 cases (8.96%) as and grade C in 2 cases (2.99%). ROC curve analysis showed that DFA1 had significant predictability on PF (P<0.05), and the sensitivity, specificity, PPV and NPV were 100%, 80.8%, 60.0% and 100.0% respectively at the cutoff value of 340 U/L. Univariate analysis indicated that DFA1, pancreatic duct diameter ≤ 3 mm and soft pancreatic texture were risk factors for PF (all P<0.05), and the Logistic regression analysis identified that DFA1 was an independent risk factor for PF (P<0.05). Conclusion: DFA1 is an independent risk factor for PF and has better value in predicting PF. Aggressive preventive measures should be made against PF in patients with DFA1>340 U/L.
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