目的:本研究旨在评估使用术前超声(US)观察到的高回声胰腺(HP)严重程度作为临床相关术后胰瘘(CR-POPF)的预测指标的有效性。
方法:对2006年4月至2021年3月期间接受胰腺切除术的94例患者进行了回顾性研究。HP对美国的严重程度分为两类(正常至轻度与中度至重度[明显HP])。分析术前和术中多个参数以预测CR-POPF。
结果:在94名患者中,21例(22%)患者发生CR-POPF,30例(32%)观察到明显的HP。单因素分析显示,中度至重度HP(明显HP)与CR-POPF的发生率显着相关(P&lt;0.001)。没有胰腺炎等因素,小的主胰管(<3mm),术中软胰腺,身体质量指数增加,较低的胰腺衰减和衰减指数也与CR-POPF相关(均P<0.05)。多因素分析显示,HP和胰腺质地明显是CR-POPF的独立预测因子,比值比为11.53(P=0.001)和14.12(P=0.003),分别。明显的HP和软胰腺质地的组合为CR-POPF提供了最准确的预测。
结论:HP的严重程度,如在术前US上观察到的,与CR-POPF显著相关。重度HP可以作为POPF的临床有用预测因子,特别是当术中胰腺质地评估时。
OBJECTIVE: This study aimed to evaluate the effectiveness of using the severity of hyperechoic pancreas (HP) observed on preoperative ultrasonography (US) as a predictor of clinically relevant postoperative pancreatic fistula (CR-POPF).
METHODS: A retrospective study was conducted with 94 patients who underwent pancreatectomy between April 2006 and March 2021. The severity of HP on US was classified into two categories (normal to mild vs. moderate to severe [obvious HP]). Multiple preoperative and intraoperative parameters were analyzed to predict CR-POPF.
RESULTS: Out of the 94 patients, CR-POPF occurred in 21 (22%) patients, and obvious HP was observed in 30 (32%). Univariate analysis revealed that moderate to severe HP (obvious HP) was significantly associated with an increased incidence of CR-POPF (P<0.001). Factors such as the absence of pancreatitis, a small main pancreatic duct (<3 mm), intraoperative soft pancreas, increased body mass index, and lower pancreatic attenuation and attenuation index were also associated with CR-POPF (all P<0.05). Multivariate analysis showed that obvious HP and soft pancreatic texture were independent predictors of CR-POPF, with odds ratios of 11.53 (P=0.001) and 14.12 (P=0.003), respectively. The combination of obvious HP and soft pancreatic texture provided the most accurate prediction for CR-POPF.
CONCLUSIONS: The severity of HP, as observed on preoperative US, was significantly associated with CR-POPF. Severe HP may serve as a clinically useful predictor of POPF, especially when evaluated alongside the intraoperative pancreatic texture.