| 摘要 |
Background: Grade C pancreatic fistula (PF) is the most dangerous complication after pancreaticoduodenectomy (PD) and had not been identified on the early postoperative day yet. In this study, we aimed to introduce a new approach to distinguish grade C from grade B PF by using features on the 5th postoperative day’s computed tomography (CT).
Materials andMethods: A bicentric prospective cohort study was conducted from August 2021 to October 2023 at the University Medical Center (UMC) and Cho Ray Hospital, Vietnam. Patients who diagnosed pancreatic fistula and underwent a CT scan on the 5th postoperative day were followed up within 90 days after PD. The characteristics of CT scan images were analyzed to differentiate both grades of PF.
Results: During 26 months, 77 patients with periampullary cancer underwent PD and met the criteria of the study (46 males, mean age: 57.1 ± 13.7). Of these, 52 patients had biochemical PF and 25 had CRPF (18 grade B PFs and 7 grade C PFs). Specifications on the 5th postoperative day’s CT scan that can discriminate grade C from grade B included fluid diffusing throughout abdomen, retroperitoneal abscess, hematoma beneath the liver, size of the fluid collection next to the pancreas (P = 0.031), and size of pancreatojejunostomy anastomosis dehiscence (P = 0.045).
Conclusions: Features on CT scan could be used to identify grade C pancreatic fistula from the 5th postoperative day. This result can
help surgeons to make a plan for a careful follow-up and early reoperation for those patients. |
