Clinical Implications of Postoperative Hyperamylasemia after Partial Pancreaticoduodenectomy.

IF 1.8 4区医学 Q3 GASTROENTEROLOGY & HEPATOLOGY Visceral Medicine Pub Date : 2022-12-01 Epub Date: 2022-10-24 DOI:10.1159/000526495

Ioannis Mintziras, Sabine Wächter, Jerena Manoharan, Veit Kanngiesser, Elisabeth Maurer, Detlef K Bartsch

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引用次数: 1

Abstract

Introduction: The present study aimed to examine the clinical implications of postoperative hyperamylasemia (POH) after partial pancreaticoduodenectomy (PD).

Methods: Data from all consecutive patients undergoing PD were obtained from a prospectively maintained database and reviewed. POH was defined as an elevation of serum pancreatic amylase above the upper limit of normal (53 U/L) on postoperative days 0-2. Clinically relevant POH (cr-POH) was defined as POH in patients with clinically relevant (Clavien-Dindo ≥ III) postoperative complications.

Results: POH occurred in 61 of 170 (35.9%) and cr-POH in 24 of 170 (14.1%) patients. Patients with POH had higher rates of clinically relevant postoperative pancreatic fistula (cr-POPF) (44.3 vs. 3.7%, p < 0.001) and clinically relevant postoperative complications than those without POH (39.3 vs. 21.1%, p = 0.001). Patients with cr-POH had higher C-reactive protein (CRP, milligrams per liter) levels on third (257.7 vs. 187.85 mg/L, p = 0.016) and fourth (222.5 vs. 151, p = 0.002) postoperative day (POD) than those with POH alone. Serum procalcitonin (PCT, micrograms per liter) levels on POD 2 (1.2 vs. 0.4 μg/L, p = 0.028) and POD 3 (0.85 vs. 0.4 μg/L, p = 0.001) were also higher in patients with cr-POH. Rates of cr-POPF in patients with cr-POH were higher than in those with POH alone (70.8 vs. 27%, p = 0.001). POH (OR 0.011, 95% CI: 0.001-0.097, p < 0.001) was an independent predictor of cr-POPF in the multivariable analysis. A high-risk pathology, defined as nonadenocarcinoma/nonchronic pancreatitis pathology (OR 0.277, 95% CI: 0.106-0.727, p = 0.009), and a small duct diameter (OR 0.333, 95% CI: 0.139-0.796, p = 0.013) were independent predictors of POH in the multivariable analysis.

Conclusion: POH is a frequent, but not always clinically relevant, finding after partial PD. Serum CRP and PCT levels in the early postoperative period can be used to identify patients with cr-POH. POH is an independent risk factor for increased postoperative morbidity, including cr-POPF, after partial PD.

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胰十二指肠部分切除术后高淀粉酶血症的临床意义。

本研究旨在探讨部分胰十二指肠切除术(PD)后高淀粉酶血症(POH)的临床意义。方法:从前瞻性维护的数据库中获得所有连续PD患者的数据并进行回顾。POH定义为术后0-2天血清胰淀粉酶高于正常上限(53 U/L)。临床相关POH (cr-POH)定义为有临床相关(Clavien-Dindo≥III)术后并发症的患者的POH。结果:170例患者中POH 61例(35.9%)，cr-POH 24例(14.1%)。POH患者术后临床相关胰瘘(cr-POPF)发生率(44.3比3.7%，p < 0.001)和术后临床相关并发症发生率(39.3比21.1%，p = 0.001)均高于无POH患者。术后第3天(257.7 vs. 187.85 mg/L, p = 0.016)和第4天(222.5 vs. 151, p = 0.002)， cr-POH患者的c反应蛋白(CRP，毫克/升)水平高于单纯POH患者。cr-POH患者血清降钙素原(PCT，微克/升)POD 2 (1.2 vs. 0.4 μg/L, p = 0.028)和POD 3 (0.85 vs. 0.4 μg/L, p = 0.001)水平也较高。cr-POH患者的cr-POPF发生率高于单纯POH患者(70.8 vs 27%， p = 0.001)。在多变量分析中，POH (OR 0.011, 95% CI: 0.001-0.097, p < 0.001)是cr-POPF的独立预测因子。在多变量分析中，高风险病理，定义为非腺癌/非慢性胰腺炎病理(OR 0.277, 95% CI: 0.106-0.727, p = 0.009)和小导管直径(OR 0.333, 95% CI: 0.139-0.796, p = 0.013)是POH的独立预测因子。结论:POH是部分PD后常见的，但并不总是与临床相关。术后早期血清CRP和PCT水平可用于鉴别cr-POH患者。POH是部分PD后术后发病率增加的独立危险因素，包括cr-POPF。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Visceral Medicine Medicine-Surgery

CiteScore

4.50

自引率

0.00%

发文量

期刊介绍： This interdisciplinary journal is unique in its field as it covers the principles of both gastrointestinal medicine and surgery required for treating abdominal diseases. In each issue invited reviews provide a comprehensive overview of one selected topic. Thus, a sound background of the state of the art in clinical practice and research is provided. A panel of specialists in gastroenterology, surgery, radiology, and pathology discusses different approaches to diagnosis and treatment of the topic covered in the respective issue. Original articles, case reports, and commentaries make for further interesting reading.