内镜下与经皮引流放置左侧胰腺切除术后：多状态模型定义胰瘘介入治疗的客观变量。

IF 2.4 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Hpb Pub Date : 2025-10-01 DOI:10.1016/j.hpb.2025.06.012

Matthäus Felsenstein , Sophie Dorfer , Ann-Christin Amini , Regina Stegherr , Aboelyazid Elkilany , Niklas M. Stephan Mirwald , Uli Fehrenbach , Dou Ma , Cao Z. Jing Jin , Mengwen Hu , Ruonan Wang , Lea Timmermann , Karl H. Hillebrandt , Ulrike Grittner , Igor M. Sauer , Christian Jürgensen , Johann Pratschke , Thomas Malinka

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引用次数: 0

摘要

背景：术后胰瘘（POPF）仍然是左侧胰腺切除术后常见的并发症。介入治疗是经常需要的，并且依赖于跨学科的概念，包括介入放射学和内窥镜检查。需要关于现有治疗方式的正确适应症和临床算法的证据。方法：在5年的观察期内，我们对200例左侧胰腺切除术患者的临床过程进行了跟踪。确定符合介入相关（IR-） POPF临床和影像学标准的患者。通过已建立的描述性分析的升级概念和基于决策的比较分析算法对介入治疗组进行分层。我们使用多状态时间到事件模型（MSM）来评估临床解决效果。结果：手术后，IR-POPF患者需要多次（58.2%）和多模式（49.4%）干预才能达到最终解决。与PD组（23.4d, 95%CI[2.8-17.9d]）相比，ED组的技术成功率（57.7%）高于PD组（32.7%），并导致更早的分辨率（8.4d, 95%C [5.5-11.2d]）。在任何给定时间，在多方面的MSM分析中，ED达到临床解决的概率更高（HR 1.39, 95%CI[0.854, 2.25]）。结论：本研究强调了内镜引导下左侧胰腺切除术后引流的重要性。CRP值似乎是优化治疗分配的单一客观参数。

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Endoscopic versus percutaneous drainage placement after left-sided pancreatectomy: multi-state model for defining objectifiable variables on interventional treatment for pancreatic fistula

Background

Postoperative pancreatic fistula (POPF) remains a prevalent complication after left-sided pancreatectomy. Interventional treatment is regularly required and relies on interdisciplinary concepts, including interventional radiology and endoscopy. Evidence on the correct indication and clinical algorithms for available treatment modalities are needed.

Methods

During a 5-year observational period, we followed the clinical courses of 200 patients after left-sided pancreatectomy. Patients who fulfilled clinical and radiographic criteria for interventionally-relevant(IR-) POPF were identified. Interventional treatment groups were stratified via established step-up concepts for descriptive analyses and via a decision-based algorithm for comparative analyses. We used a Multi-State Time-to-Event Model (MSM) to assess clinical resolution efficacy.

Results

Following surgery, patients with IR-POPF needed multiple (58.2 %) and multimodal (49.4 %) interventions to achieve final resolution. Technical success rates were higher in ED (57.7 %) versus PD (32.7 %), and resulted in earlier resolution (8.4d, 95%C [5.5–11.2d]) when compared to the PD group (23.4d, 95%CI[2.8–17.9d]). At any given time, probability of reaching clinical resolution were higher for ED in multifaceted MSM analysis (HR 1.39, 95%CI[0.854, 2.25]).

Conclusion

The present study highlights the importance of endoscopy-guided drainage placement after left-sided pancreatic resection. CRP value appeared to be a single objectifiable parameter for optimized treatment allocation.

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来源期刊

Hpb GASTROENTEROLOGY & HEPATOLOGY-SURGERY

CiteScore

5.60

自引率

3.40%

发文量

244

审稿时长

57 days

期刊介绍： HPB is an international forum for clinical, scientific and educational communication. Twelve issues a year bring the reader leading articles, expert reviews, original articles, images, editorials, and reader correspondence encompassing all aspects of benign and malignant hepatobiliary disease and its management. HPB features relevant aspects of clinical and translational research and practice. Specific areas of interest include HPB diseases encountered globally by clinical practitioners in this specialist field of gastrointestinal surgery. The journal addresses the challenges faced in the management of cancer involving the liver, biliary system and pancreas. While surgical oncology represents a large part of HPB practice, submission of manuscripts relating to liver and pancreas transplantation, the treatment of benign conditions such as acute and chronic pancreatitis, and those relating to hepatobiliary infection and inflammation are also welcomed. There will be a focus on developing a multidisciplinary approach to diagnosis and treatment with endoscopic and laparoscopic approaches, radiological interventions and surgical techniques being strongly represented. HPB welcomes submission of manuscripts in all these areas and in scientific focused research that has clear clinical relevance to HPB surgical practice. HPB aims to help its readers - surgeons, physicians, radiologists and basic scientists - to develop their knowledge and practice. HPB will be of interest to specialists involved in the management of hepatobiliary and pancreatic disease however will also inform those working in related fields. Abstracted and Indexed in: MEDLINE® EMBASE PubMed Science Citation Index Expanded Academic Search (EBSCO) HPB is owned by the International Hepato-Pancreato-Biliary Association (IHPBA) and is also the official Journal of the American Hepato-Pancreato-Biliary Association (AHPBA), the Asian-Pacific Hepato Pancreatic Biliary Association (A-PHPBA) and the European-African Hepato-Pancreatic Biliary Association (E-AHPBA).