| Objectives:The constantly monitoring of the amylase and lipase of peritoneal d rainage fluid after duodenopancreatectomy in different stages to observe patients ’postoperative changes,dignose postoperative pancreatic fistula and analyse the clinical guideline value of the best timing of extracting peritoneal drainage.Methods:Retrospectively analyzed the clinical date of 82 patients after pancreat icojejunostomy from September 2012 to December 2014, in the department of hepatobiliary surgery of the First Affiliated Hospital of Kunming Medical Univ ersity,By measuring the pancreatic intestinal anastomotic posterior peritoneal dra inage in postoperative 24h,72h,120h and 168h of amylase and lipase index a nd corresponding serum amylase, lipase time index and depending on the verba 1 rating scales and criteria for the diagnosis of pancreatic fistula in the internat ional pancreatic fistula research group,the analysis of the best timing for extrac ting the pancreatic intestinal anastomotic posterior peritoneal drainage is based on one sample T test and LSD-T test to compare the amylase and lipase inde x of peritoneal drainage fluid and serum in the different period,calculate the rat io between drainage fluid and serum and observe the degree of abdominal painResults:In postoperative 24h the average index of drainage fluid amylase(A1 gr oup) is 829.61±530.91 U/L,the average index of drainage fluid lipase(al group) is 837.12±504.44 U/L,the average index of serum amylase(B1 group) is 225.9 8±155.91 U/L,the average index of serum lipase is 169.76±65.82 U/L,the avera ge ratio of amylase between drainage fluid and serum is 4.22±2.54, the averag e ratio of lipase between drainage fluid and serum is 5.40±3.08.In postoperativ e 72h the average index of drainage fluid amylase(A2 group) is 332.72±134.89 U/L,the average index of drainage fluid lipase(a2 group) is 332.98±140.23 U/ L,the average index of serum amylase(B2 group) is 124.02±49.04 U/L,the avera ge index of serum lipase is 166.49±36.87 U/L,the average ratio of amylase bet ween drainage fluid and serum is 2.72±0.83, the average ratio of lipase betwee n drainage fluid and serum is 2.01±0.80,the above data show that the index in A2 group is more significantly decreased than that in A1 group,P<0.05,the di fference is significant,meanwhile the index in B2 group is more significantly d ecreased than that in B1 group,P<0.05, the difference is significant,but the stat istical difference between al group and a2 group(P=0.257) is no significant. In postoperative 120h the average index of drainage fluid amylase(A3 group) is 151.12±49.52 U/L,the average index of drainage fluid lipase(a3 group) is 163.2 3±71.86 U/L,the average index of serum amylase(B3 group) is 83.60±25.53 U/ L,the average index of serum lipase is 160.27±42.99 U/L,the average ratio of a mylase between drainage fluid and serum is 1.96±0.85, the average ratio of lip ase between drainage fluid and serum is 1.13±0.59,according to the comparsion among above data:the interdependency of A1 group and A3 group,A2 group and A3 group, B1 group and A3 group,B2 group and B3 group are P<0.05,th e difference among the different groups is significant,meanwhile the interdepend ency of al group and a3 group,a2 group and a3 group are P<0.05,the differe nce is significant.In postoperative 168h the average index of drainage fluid am ylase(A4 group) is 87.91±29.57 U/L,the average index of drainage fluid lipase( a4 group) is 127.38±32.50 U/L,the average index of serum amylase(B4 group) is 76.67±27.30 U/L,the average index of serum lipase is 145.49±29.18 U/L,the average ratio of amylase between drainage fluid and serum is 1.31±0.66, the a verage ratio of lipase between drainage fluid and serum is 0.91±0.29,the relatib ities of A1 group and A4 group,A2 group and A4 group, B1 group and B4 gr oup, B2 group and A4 group, al group and a4 group, a2 group and a4 group are P<0.05,the differences are significant,the statistical difference between A3 group and A4 group(P=0.100) is no significant, the statistical difference betwe en B3 group and B4 group(P=0.473) is no significant, the statistical difference between a3 group and a4 group(P=0.473) is no significant.According to the cla ssification of patients with abdominal pain as grade Ⅰ、Ⅱ、Ⅲ、Ⅳ,postoperative 24h(P1 group)、72h(P2 group)、120h(P3 group)、168h(P4 group) are grouped b y the pain classification, the interdependency of P1 group and P2 group, P2 gr oup and P3 group are P<0.05,the differences are significant, the statistical diff erence between P3 group andP4 group(P=0.687) is no significant; the postopera tive mean extubation time is 5.11±0.94D. In summary,the index of serum lipase has been in the normal range so that the statistical difference has no mean; t he biochemical indicator intercomparison between drainage fluid and serum has significance in postoperative different period for the diagnosis of postoperative complications and instruction to extract peritoneal drainage is significant.Conclusion:To monitor biochemical indicators of peritoneal drainage fluid and serum in the postoperative different period, observe changes of patients’clinic al manifestation and the comparison of extraction time of peritoneal drainage t ube, and above data show that postoperative 120h is a relatively safe timing w hen patients showed clinical remission apparently and the whole process can m onitor the occurrence and development of POPF so that it is easy to detect an d deal with unexpected emergencies. |
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