AIM: To allow the identification of high-risk postoperative pancreatic fistula (POPF) patients with special reference to the International Study Group on Pancreatic Fistula (ISGPF) classification.METHODS: Between 1997 and 2010, 1341 consecutive patients underwent gastrectomy for gastric cancer at the Department of Digestive Surgery, Kyoto Prefectural University of Medicine, Japan. Based on the preoperative diagnosis, total or distal gastrectomy and sufficient lymphadenectomy was performed, mainly according to the Japanese guidelines for the treatment of gastric cancer. Of these, 35 patients (2.6%) were diagnosed with Grade B or C POPF according to the ISGPF classification and were treated intensively. The hospital records of these patients were reviewed retrospectively.RESULTS: Of 35 patients with severe POPF, 17 (49%) and 18 (51%) patients were classified as Grade B and C POPF, respectively. From several clinical factors, the severity of POPF according to the ISGPF classification was significantly correlated with the duration of intensive POPF treatments (P = 0.035). Regarding the clinical factors to distinguish extremely severe POPF, older patients (P = 0.035, 65 years ≤ vs < 65 years old) and those with lower lymphocyte counts at the diagnosis of POPF (P = 0.007, < 1400/mm3 vs 1400/mm3 ≤) were significantly correlated with Grade C POPF, and a low lymphocyte count was an independent risk factor by multivariate analysis [P = 0.045, OR = 10.45 (95%CI: 1.050-104.1)].CONCLUSION: Caution and intensive care are required for older POPF patients and those with lower lymphocyte counts at the diagnosis of POPF.
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机译:目的:为鉴定高危术后胰瘘(POPF)患者,特别参考国际胰瘘研究小组(ISGPF)分类。方法:1997年至2010年,共有1341例连续胃癌患者接受了胃癌胃切除术。日本京都府立医科大学消化外科。根据术前诊断,主要根据日本胃癌治疗指南进行全胃或远端胃切除术和足够的淋巴结清扫术。其中,有35例(2.6%)根据ISGPF分类被诊断为B级或C级POPF并接受了强化治疗。结果:35例重度POPF患者中,有17例(49%)和18例(51%)分别为B级和C级。从几个临床因素来看,根据ISGPF分类的POPF严重程度与强化POPF治疗的持续时间显着相关(P = 0.035)。关于区分极端严重POPF的临床因素,老年患者(P = 0.035,65岁≤vs <65岁)和诊断为POPF时淋巴细胞计数较低的患者(P = 0.007,<1400 / mm 3 sup> vs 1400 / mm 3 sup>≤)与C级POPF显着相关,而淋巴细胞计数低是多因素分析的独立危险因素[P = 0.045,OR = 10.45(95% CI:1.050-104.1)]。结论:对于年龄较大的POPF患者和诊断为POPF的淋巴细胞计数较低的患者,需要谨慎和重症监护。
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