The Application Value Of Pancreatic Fistula Risk Score System (FRS) In Predicting Pancreatic Fistula After Pancreaticoduodenectomy

Objective To study the risk factors of pancreatic fistula after pancreaticoduodenecTomy,and to explore the clinical application value of the clinical pancreatic fistula risk score(FRS)system recommended by the professional chapter of pancreatic diseases of the Chinese medical association in 2017 in predicting pancreatic fistula after pancreaticoduodenectomy(PD).Methods Clinical data of 169 patients with PD admitted to general hospital of Ningxia Medical university from January 2012 to September 2018 were collected.Pancreatic fistula was diagnosed strictly according to the definition of the international pancreatic fistula research group.According to the FRS prediction system of four indicators(pancreas texture,pathological results,pancreatic duct diameter,intraoperative blood loss rate,where 0 points is defined as a negligible risk,1 to 2 points for low-risk patients,3-6 is divided into medium risk patients,7-10 into the high-risk patients,and may be associated with pancreatic fistula occurred in the risk factors for the single factor analysis.Counting data were tested,and measurement data were tested by t test.The statistically significant factors were analyzed by multivariate Logistic regression.The sensitivity and specificity of the scoring system for postoperative pancreatic fistula were analyzed by using the ROC curve.Results A total of 47 patients(24 cases of clinical pancreatic fistula)developed pancreatic fistula after PD in 169 patients,including 23 cases of biochemical leakage,16 cases of grade B,and 8 cases of grade C.The univariate analysis of clinical POPF showedthat the quality of pancreas,diameter of pancreatic duct,pathological type,postoperative blood lactic acid and intraoperative blood loss had a clear influence on the occurrence of postoperative clinical pancreatic fistula(P<0).05).Multivariate analysis showed that pancreatic soft texture(OR=4,221),pancreatic duct diameter < 3mm(OR=4,221),postoperative blood lactic acid 2.5mmol/L(OR=0.261)and intraoperative blood loss 400ml(OR=0.087)were independent risk factors for postoperative clinical pancreatic fistula(P <0.05).Among the 4 indicators of clinical FRS system,there was statistical significance for the detection of clinical pancreatic fistula(P<0).05).The results of ROC curve analysis showed that the FRS system had a sensitivity of 0.958,a specificity of 0.792 and an AUC of0.742(95%ci: 0.630-854)in predicting pancreatic fistula after PD.Conclusion Before pancreaticoduodenectomy,the clinical FRS system can be used to predict the incidence of pancreatic fistula.