Abstract:

Validation and evaluation of the 2016 ISGPS definition and grading scheme of postoperative pancreatic fistula           ZHANG Ao-ran*，XU Jing-yong，TANG Bing-jun，et al. *Department of Surgery，Peking University First Hospital，Beijing 100034，China
Corresponding author：YANG Yin-mo，E-mail：yangyinmo@263.net
ZHANG Ao-ran and XU Jing-yong are the first authors who contributed equally to the article
Abstract    Objective    To validate the 2016 ISGPS definition and grading scheme and investigate whether it segregates into distinct subclasses. Methods    A total of 522 patients undergone pancreaticoduodenectomy in two pancreatic centers were reviewed. The 2016 ISGPS scheme was validated by comparing clinical and economic outcomes between different ISGPS grades. B-POPF were divided into 2 subgroups as B1 (without invasive procedures) and B2 (with invasive procedures) then outcomes were analyzed across the subgroups. Results    Biochemical leak (BL) did not differ from the non-fistula condition in all outcomes except postoperative hospital stay and cost. Non-fistula/BL，B-POPF and C-POPF condition differed significantly in terms of all clinical and economic outcomes except 30-day readmission rate. B1 differ from B2 subgroup greatly in terms of most critical terms of outcomes such as hemorrhage (15.2% vs. 34.3%，P=0.045)，biliary fistula (13.0% vs 34.3%，P=0.023)，postoperative hospital stay (32.0 d vs. 39.0 d，P=0.011). Conclusion    The present study has confirmed the effectiveness of the 2016 ISGPS definition and grading scheme in identifying three conditions that differ in terms of clinical and economic outcomes. Subclassification of B-POPF according to whether invasive procedures has been used has potential implications for accurate reporting and performance evaluation.

Key words: pancreaticoduodenectomy, pancreatic fistula, complication

摘要：

目的    验证2016版国际胰腺外科研究小组（ISGPS）胰瘘分级系统的有效性，并探讨对B级胰瘘进行亚组分级的必要性与可行性。方法    回顾性分析 2013年5月至2018年5月北京大学第一医院（305例）和北京医院（217例）连续收治的522例胰十二指肠切除术（PD）病人临床资料，比较ISGPS不同分级病人的临床结局（出血、胆瘘、腹腔感染、胃排空延迟、术后ICU住院时间、术后住院时间、住院费用），根据是否行有创操作将B级胰瘘细分为B1亚组及B2亚组，对比两组间临床结局。结果    生化漏与无胰瘘组病人比较，除术后住院时间和住院费用外的临床结局指标差异均无统计学意义（P<0.05）。无胰瘘/生化漏组、B级胰瘘组及C级胰瘘组组间比较，除30 d内再入院率外的结局指标差异均有统计学意义。B1亚组与B2亚组在出血（15.2% vs. 34.3%，P=0.045）、胆瘘（13.0% vs. 34.3%，P=0.023）和术后住院时间（32 d vs. 39 d，P=0.011）等方面差异有统计学意义。结论    ISGPS（2016版）胰瘘分级系统具有较强的可操作性和鉴别效能；据是否行有创治疗将B级胰瘘再细化分层，具有合理性和可操作性。

关键词: 胰十二指肠切除术, 胰瘘, 并发症