Postoperative Serum Amylase Predicts Pancreatic Fistula Formation Following Pancreaticoduodenectomy

作者：Cloyd Jordan M; Kastenberg Zachary J; Visser Brendan C; Poultsides George A; Norton Jeffrey A^*

来源：Journal of Gastrointestinal Surgery, 2014, 18(2): 348-353.

DOI：10.1007/s11605-013-2293-3

• Whipple pancreaticoduodenectomy
• Pancreatic fistula
• Complications
• Pancreatic cancer

Early identification of patients at risk for developing pancreatic fistula (PF) after pancreaticoduodenectomy (PD) may facilitate prevention or treatment strategies aimed at reducing its associated morbidity.
A retrospective review of 176 consecutive PD performed between 2006 and 2011 was conducted in order to analyze the association between the serum amylase on postoperative day 1 (POD1) and the development of PF.
Serum amylase was recorded on POD1 in 146 of 176 PD cases (83.0 %). Twenty-seven patients (18.5 %) developed a postoperative PF: 6 type A, 19 type B, and 2 type C. Patients with a PF had a mean serum amylase on POD1 of 659 +/- 581 compared to 246 +/- 368 in those without a fistula (p < 0.001). On logistic regression, a serum amylase > 140 U/L on POD1 was strongly associated with developing a PF (OR, 5.48; 95 % CI, 1.94-15.44). Sensitivity and specificity of a postoperative serum amylase > 140 U/L was 81.5 and 55.5 %, respectively. Positive and negative predictive values were 29.3 and 93.0 %, respectively.
An elevated serum amylase on POD1 may be used, in addition to other prognostic factors, to help stratify risk for developing PF following PD.

• 出版日期2014-2