The value of drain fluid amylase as a predictor of postoperative pancreatic fistula after pancreaticogastrostomy
- 주제(키워드) Pancreaticoduodenectomy , pancreaticogastrostomy , drain fluid amylase , pancreatic fistula , relevant postoperative pancreatic fistula
- 발행기관 아주대학교
- 지도교수 Ji Hun Kim
- 발행년도 2023
- 학위수여년월 2023. 2
- 학위명 박사
- 학과 및 전공 일반대학원 의학과
- 실제URI http://www.dcollection.net/handler/ajou/000000032460
- 본문언어 영어
- 저작권 아주대학교 논문은 저작권에 의해 보호받습니다.
초록/요약
Background/Aim: Drain fluid amylase is commonly used as a predictor of pancreatic fistula after pancreaticoduodenectomy (PD). This study aimed to determine the ideal cut-off value of drain fluid amylase on postoperative day 1 (DFA1) for predicting pancreatic fistula after pancreaticogastrostomy (PG). Patients and Methods: Prospective data of 272 consecutive patients undergoing PG between 2010 and 2020 was collected and analyzed to determine the postoperative pancreatic fistula (POPF) risk factors. Results: The incidence of POPF was 143 cases (52.6%). The median DFA1 in patients with POPF was significantly higher than that of patients with NO-POPF (5483 vs 311, P < 0.001). DFA1 correlated with POPF in the area under the curve (AUC) of 0.84 (P < 0.001). When DFA1 was 2300U/L, Youden index was the highest, with a sensitivity of 72.7% and a specificity of 82.9%. Logistic regression analysis showed that DFA1≥2300U/L was an independent predictor of POPF (P < 0.001; OR: 12.855; 95% CI: 7.019-23.544). The AUC of DFA1 and clinically relevant postoperative pancreatic fistula (CR-POPF) was 0.674 (P < 0.001). Conclusion: DFA1≥2300U/L can be used as an independent predictor of POPF after PG. DFA1≥3000U/L can predict the occurrence of CR-POPF, when DFA1≥3000U/L, the patients should be observed closely active for complications.
more목차
Ⅰ. INTRODUCTION 1
Ⅱ. PATIENTS AND METHODS 4
A. Patient Selection 5
B. Surgical Technique 5
C. Postoperative Management 6
D. Definition of Postoperative Complications 7
E. Statistical Method 8
Ⅲ. RESULTS 10
A. Patient Characteristics 11
B. The Relationship between Patient-related Factors and POPF 14
C. Derivation of the Cut-off Value of DFA1 for POPF Prediction 22
D. Logistic regression verifies that DFA1 is an independent predictor of POPF 25
E. Logistic Regression Verifies the Prediction of POPF by the Cut-off Value of DFA1 29
F. The Relationship between Patient-related Factors and CR-POPF 33
Ⅳ. DISCUSSION 39
Ⅴ. CONCLUSION 46
