背景:胰体尾切除术瘘风险评分(D-FRS)和DISPAIR-FRS在预测胰体尾切除术(DP)术后胰瘘(POPF)方面尚未得到广泛验证。
方法:我们回顾性分析了104例接受DP的患者。比较D-FRS和DISPAIR-FRS的预测价值。通过多因素分析调查与POPF相关的危险因素。
结果:在104例患者中,23(22.1%)被归类为POPF组(均为B级)。D-FRS(术前)的ROC(AUC)下的区域,D-FRS(术中),DISPAIR-FRS分别为0.737、0.809和0.688。按D-FRS(术前)分层,低风险的POPF率,中等风险,高危人群占5%,22.6%,和36.4%,分别。通过D-FRS(术中),低风险的POPF率,中等风险,高危人群占8.8%,47.1%,和47.4%,分别。通过DISPAIR-FRS,低风险的POPF率,中等风险,极端高危人群占14.8%,23.8%和62.5%,分别。术前(P=0.014,P=0.033)和术中(P=0.015,P=0.039)体重指数和主胰管直径是POPF的独立危险因素。
结论:D-FRS(术前)D-FRS(术中),DISPAIR-FRS在DP后的POPF预测中具有良好的性能。在目前的亚洲队列中,风险分层并不令人满意。
BACKGROUND: Distal pancreatectomy fistula risk score (D-FRS) and DISPAIR-FRS has not been widely validated for predicting postoperative pancreatic fistula (POPF) after distal pancreatectomy (DP).
METHODS: We retrospectively analysed 104 patients undergoing DP. The predictive value of the D-FRS and DISPAIR-FRS were compared. Risk factors associated with POPF were investigated by multivariate analysis.
RESULTS: Of the 104 patients, 23 (22.1%) were categorized into the POPF group (all grade B). The areas under the ROC (AUCs) of the D-FRS (preoperative), D-FRS (intraoperative), and DISPAIR-FRS were 0.737, 0.809, and 0.688, respectively. Stratified by the D-FRS (preoperative), the POPF rates in low-risk, intermediate-risk, and high-risk groups were 5%, 22.6%, and 36.4%, respectively. By the D-FRS (intraoperative), the POPF rates in low-risk, intermediate-risk, and high-risk groups were 8.8%, 47.1%, and 47.4%, respectively. By the DISPAIR-FRS, the POPF rates in low-risk, intermediate-risk, and extreme-high-risk groups were 14.8%, 23.8% and 62.5%, respectively. Body mass index and main pancreatic duct diameter were independent risk factors of POPF both in preoperative (P = 0.014 and P = 0.033, respectively) and intraoperative (P = 0.015 and P = 0.039) multivariate analyses.
CONCLUSIONS: Both the D-FRS (preoperative), D-FRS (intraoperative), and DISPAIR-FRS has good performance in POPF prediction after DP. The risk stratification was not satisfactory in current Asian cohort.