胰腺术后引流液监测诊断胰漏的价值

目的探讨胰腺手术后引流液监测在诊断胰漏中的价值。方法前瞻性收集2005年11月至2006年7月复旦大学附属中山医院收治的42例胰腺术后腹腔内胰肠吻合口处引流液进行淀粉酶测定，同时记录病人术后相应的临床资料和腹腔引流液的性状。结果42例病人中有12例出现胰漏，单因素分析发现引流液颜色从淡黄夹杂淡血色变为灰褐色的动态变化、淀粉酶值的增高趋势、术后第7天的引流液颜色、术后第7天中性粒细胞比例和术后第7天空腹血糖是具有显著性意义的相关因素（P〈0．05）；ROC曲线分析示引流液颜色动态变化、淀粉酶值的变化趋势、术后第7天中性粒细胞比例具有较好的诊断效能。结论术后引流液颜色动态变化、淀粉酶值的增高趋势、术后第7天中性粒细胞比值能有效判断胰漏的发生，有利于临床早期认识胰漏，对于这种病人应该采取积极的干预措施来预防严重并发症的发生。

Diagnostic value of monitoring intraabdominal fluid for postoperative pancreatic fistula

Objective To investigate the diagnostic value of monitoring drained intraabdominal fluid for postoperative pancreatic fistula (POPF).Methods Drained fluid around the anastomosis was collected from 42 patients,who underwent pancreatoenterostomy during November 2005 to July 2006,for detecting amylase value.The definition of an international study group,which consisted of 37 institutions, was used to diagnose POPF.Clinical data and the drained fluid characteristics of all the patients were recorded.Results Among the 42 patients,12 patients suffered POPF.By univariate analysis,it was found that color change of drained fluid from light yellow bloody to grey brown(P=0.002),increased value of amylase in the drained fluid (P=0.001),the color of drained fluid and the percentage of granulocyte in WBC (P<0.05) as well as the fasting blood glucose (P=0.009) on the 7th day after surgery were significant relevant factors.Color change of drainage fluid and the amylase value change were both independent risk factors for POPF by multivariate analysis (odds ratio are 11.62 and 11.18,respectively).By ROC curve analysis,color change of drained fluid (P=0.017),increased value of amylase (P =0.007) and the percentage of granulocyte in WBC on the 7th after surgery (P=0.004)had good diagnostic values for POPF.Combination of the increased value of amylase and N %> 80% had a better diagnostic value with a 0.833 area under the ROC curve (P=0.001).Conclusion By color change,increased amylase value of drained intraabdominal fluid and granulocyte percentage on the 7th after surgery.POPF may be diagnosed in an early stage effectively.Active intervention should be adopted to prevent serious complications.