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The Journal of surgical research 切缘组织学对胰十二指肠切除术后胰瘘发生的影响。
影响因子：2.417 DOI：10.1016/j.jss.2018.02.052
作者： Harrell KN,Jajja MR,Postlewait LM,Memis B,Maithel SK,Sarmiento JM,Adsay NV,Kooby DA 发表时间：2020-07-10 11:55:37
from：《JOURNAL OF SURGICAL RESEARCH》
keywords： Harrell KNJajja MRPostlewait LMMemis BMaithel SKSarmiento JMAdsay NVKooby DA
关键词： 并发症 结果 胰腺切除术 胰瘘 胰十二指肠切除术
Abstract
BACKGROUND:Postoperative pancreatic fistula (POPF) is a potentially debilitating complication following pancreatoduodenectomy (PD). There are limited data correlating pancreatic parenchymal histopathologic features specifically fat and fibrosis content with development of POPF after PD. METHODS:Patients who underwent PD (January 2010-May 2015) with archived pathologic slides were included. Each pancreatic neck transection margin was histologically graded for fat and fibrosis, scored from 0 to 4, and grader was blinded to clinical outcomes. Main pancreatic duct diameter and duct wall thickness were microscopically measured. Patients were dichotomized into high and low categories with respect to pancreatic fat and fibrosis and primary outcome of POPF. RESULTS:Of 301 patients, 24 developed POPF (8.0%). One hundred ten patients (36.5%) had low fat (score <2), and 149 (49.5%) had low fibrosis (score <2), and average duct diameter was 3.9 ± 1.3 mm. Patients with low fibrosis had a higher rate of POPF (12.8% versus 3.3%, P = 0.005). Low fibrosis (odds ratio [OR] 4.29, 95% confidence interval [CI] 1.56-11.7, P = 0.005), nonpancreatic adenocarcinoma pathology (OR 3.25, 95% CI 1.25-8.43, P = 0.02), and increased body mass index (BMI) (OR 1.11, 95% CI 1.03-1.12, P = 0.007) were associated with POPF development on univariate analysis. Low fibrosis and increased BMI remained independently associated on multivariate analysis. High fat content was frequently concurrently identified in specimens with high fibrosis (67.8%). Surgeon-described gland consistency did not correlate with histopathologic findings (Spearman's rank correlation coefficients of -0.144 and 0.304, respectively) or to incidence of POPF. No patient who underwent preoperative chemotherapy developed POPF (n = 30, 10%). CONCLUSIONS:Low pancreatic neck fibrosis content and increased patient BMI are associated with increased rates of POPF following PD, while pancreatic fat content does not appear to influence this outcome. Pancreatic neck fat and fibrosis often coexist in the same specimen. The association between preoperative chemotherapy and low POPF rates needs further examination. Frozen section analysis of pancreatic neck margin for fibrosis content may be more accurate than surgeon assessment in identifying patients at risk for POPF. These assessments can potentially guide therapeutic interventions, including selective prophylactic drain placement and use of postoperative somatostatin analog therapy.
摘 要
背景: 术后胰瘘 (POPF) 是胰十二指肠切除术 (PD) 后潜在的衰弱并发症。与PD后POPF发展相关的胰腺实质组织病理学特征，特别是脂肪和纤维化含量的数据有限。 方法: 纳入 2010 年 1 月至 2015 年 5 月用存档病理切片行PD的患者。对每个胰腺颈横断缘进行脂肪和纤维化的组织学分级，评分从 0 到 4，grader对临床结局不敏感。镜下测量主胰管直径和管壁厚度。患者在胰腺脂肪和纤维化以及POPF的主要结局方面分为高低两类。 结果: 301 例患者中，24 例发生POPF (8.0%)。36.5% 例患者 (149) 脂肪含量低 (评分 <2)，49.5% 例 (3.9) 低纤维化 (评分 <2)，平均导管直径为 1.3毫米 ± 0.。低纤维化患者POPF产生率较高 (1 2。8% 对 3.3%，P = 0.005)。低纤维化 (优势比 [OR] 4.29，95% 可信区间 [CI] 1.56-11.7，P = 0.005)，非胰腺腺癌病理 (OR 3.25，95% CI 1.25-8.43，P = 0.02)，体重指数 (BMI) 增加 (OR 1.11，95% CI 1.03-1.12，P = 0.007)在单变量分析中与POPF发展相关。多变量分析显示低纤维化和BMI增加仍然独立相关。在高纤维化标本中经常同时发现高脂肪含量 (67.8%)。外科医生描述的腺体一致性与组织病理学结果 (Spearman等级相关系数分别为-0.144 和 0.304) 或POPF发生率无关。没有接受术前化疗的患者发生POPF (n = 30，10%)。 结论: 胰腺颈部纤维化含量低和患者BMI增加与PD后POPF发生率增加相关，而胰腺脂肪含量似乎不影响这一结果。胰腺颈部脂肪和纤维化常并存于同一标本中。术前化疗与低POPF率之间的相关性需要进一步检查。在识别POPF风险患者方面，胰腺颈缘纤维化内容的冰冻切片分析可能比外科医生评估更准确。这些评估可以潜在地指导治疗干预，包括选择性预防性放置引流管和使用术后生长抑素类似物治疗。
期刊介绍
《JOURNAL OF SURGICAL RESEARCH》 (点击进入期刊详情)
英文简介 : The Journal of Surgical Research: Clinical and Laboratory Investigation publishes original articles concerned with clinical and laboratory investigations relevant to surgical practice and teaching. The journal emphasizes reports of clinical investigations or fundamental research bearing directly on surgical management that will be of general interest to a broad range of surgeons and surgical researchers. The articles presented need not have been the products of surgeons or of surgical laboratories.
中文简介 : （来自Google、百度翻译） 《外科研究杂志：临床和实验室调查》发表了与外科实践和教学有关的临床和实验室调查的原始文章。该杂志强调临床调查或基础研究的报告直接关系到外科管理，这将是广大外科医生和外科研究人员普遍感兴趣的。提交的文章不一定是外科医生或外科实验室的产品。
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总被引频次 :13406

特征因子 : 0.023120

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