基于术前评分模型对腹腔镜胰十二指肠切除术术后胰瘘风险的预测分析OACSTPCD

Objective To investigate the risk factors of postoperative pancreatic fistula(POPF)after laparoscopic pancreaticoduodenectomy(LPD),to construct a preoperative-intraoperative integrated scoring model,which was used to predict the risk of POPF preoperatively and its clinical application value was evaluated.Methods This retrospective analysis was conducted on clinical data of 176 LPD patients from Jan.2014 to Jan.2019 at Hunan Provincial People's Hospital and the First People's Hospital of Changde City.Among them,30 patients experienced grade B or higher pancreatic fistula postoperatively(28 case of grade B and 2 case of grade C).Relevant data including clinical characteristics,imaging findings,pathological features,treatment,and postoperative recovery were processed.Based on preoperative data,intraoperative data were estimated,and a preoperative-intraoperative integrated scoring model was constructed to predict the risk of POPF.Results Multivariate Logistic regression results indicated that age(P<0.001),platelet count(P<0.001),pancreatic texture(P=0.003),pancreatic duct diameter(P<0.001),and intraoperative blood loss(P<0.001)were significant factors affecting the occurrence of POPF.Based on the preoperative data of these 4 indicators—age,platelet count,pancreatic texture,and pancreatic duct diameter—the MissForest algorithm was used to estimate the intraoperative blood loss,and the accuracy rate of predicting postoperative pancreatic fistula reached 89.2%(157 out of 176 cases).The constructed scoring model,based on preoperative and estimated intraoperative data,demonstrated good predictive performance with an AUC value of 0.792.Conclusion Based on patients'preoperative physical indicators and estimated intraoperative blood loss,the preoperative-intraoperative integrated scoring model constructed in this study can accurately predict the risk of POPF after LPD.