Objective: To discuss the impact of updated definition and classification system of pancreatic fistula published in 2016 on the postoperative classification of pancreatic fistula. Methods: Retrospective analysis was made on patients who underwent pancreatic surgery at ward 1 in Department of General Surgery, Peking Union Medical College Hospital from January 2015 to December 2016.A total of 408 patients were included in this retrospective study, male/female was 184/224, aged from 9 to 81 years with mean age of 51.6 years.One hundred and fifty-two cases were performed pancreaticoduodenectomy, 125 cases for distal pancreatectomy, 43 cases for spleen preservation distal pancreatectomy, 61 cases for partital pancreatectomy or enucleation, 8 cases for middle pancreatectomy, 6 cases for pancreaticojejunostomy and 13 cases for other procedures.Clinical data including postoperative drainage fluid volume, amylase concentration, duration of hospitalization and drainage were obtained, revaluated and re-analyzed, classified grounded on 2005 edition and 2016 edition, respectively.t-test was adopted for data analysis. Results: According to the previous standards, the incident rate of pancreatic fistula was 57.4%, and the incident rate of B-level plus C-level pancreatic fistula was 35.8%, which decreased to 13.7% based on 2016 edition.Nine patients who received percutaneous puncture or endoscopic drainage was regraded from C-level to B-level. The average duration of postoperative hospitalization of patients without pancreatic fistula was (12.5±6.0)days, demonstrating no significant difference compared to (14.1±7.7)days, duration of postoperative hospitalization of A-level(under 2005 edition of criteria) pancreatic fistula group(t=1.66, P=0.09) and (12.4±6.1)days, duration of postoperative hospitalization of biochemical leakage group(t=0.14, P=0.89). Nevertheless, there was statistical significant difference between the average postoperative duration of hospitalization(30.7±16.9) days of B-level(under 2016 criteria) pancreatic fistula patients and pancreatic fistula-free patients as well as the biochemical leakage group patients (t=7.10, 7.13; both P<0.01). Conclusions: Based on the new diagnostic criteria, the incidence of postoperative pancreatic fistula decreased dramatically.New classification system downgraded part of cases graded C-level pancreatic fistula to B-level and some B-level to biochemical fistula.The new diagnostic classification and criteria facilitated clinical practice, accomplished better conformity to clinical reality and potentially enacted clinical outcome.
目的： 探讨2016版国际胰瘘研究小组定义和分级系统对胰腺术后患者胰瘘分级的影响。 方法： 回顾性分析2015年1月1日至2016年12月31日在北京协和医院基本外科一病房接受胰腺外科手术的408例患者资料，男性184例，女性224例，年龄9～81岁，平均51.6岁。其中接受胰十二指肠切除术152例，接受胰体尾加脾切除术125例，接受保留脾脏胰体尾切除术43例，接受局部切除或摘除术61例，接受胰腺节段切除术8例，接受胰管空肠吻合术6例，接受其他术式13例。记录患者术后引流液量、淀粉酶浓度、术后住院日及带管时间，分别按照2005版和2016版两个分级系统进行分级。采用t检验对数据进行分析。 结果： 根据2005版分级系统计算，408例接受胰腺手术患者总的胰瘘发生率为57.4%，其中B级和C级胰瘘发生率为35.8%；根据2016版分级系统计算，B级和C级胰瘘发生率为13.7%，9例行术后经皮穿刺或内镜引流的患者由C级降为B级。无胰瘘组患者的术后平均住院时间为(12.5±6.0)d，与2005版标准A级胰瘘组的(14.1±7.7)d的差异无统计学意义(t＝1.66，P＝0.09)，与生化漏组的(12.4±6.1)d的差异亦无统计学意义(t＝0.14，P＝0.89)。2016版标准中B级胰瘘组术后平均住院时间为(30.7±16.9)d，与无胰瘘组和生化漏组相比差异均有统计学意义(t＝7.10、7.13，P值均<0.01)。 结论： 按照2016版分级系统统计，胰瘘的发生率明显下降；2016版分级系统使原有的部分C级胰瘘降为B级胰瘘，部分B级胰瘘降为生化漏，2016版分级系统与患者转归的相关性更好。.
Keywords: Biochemical fistula; Drainage; Pancreatic fistula; Postoperative complications.