ABSTRACT
Objective:To evaluate the early predictive value of serum procalcitonin (PCT) , C-reactive protein (CRP) , and white blood cell count (WBC) levels for pancreatic fistula after pancreaticoduodenectomy (PD) .Methods:Data of 93 patients undergoing PD in Department of Pancreatic Surgery at the First Affiliated Hospital of Xinjiang Medical University from Jan. 2017 to Nov. 2019 were retrospectively analyzed. The general information of patients before surgery and postoperative pancreatic fistula were recorded. The levels of serum PCT, CRP, and WBC before surgery and 1st, 3rd, and 5th days after operation were recorded. Patients were divided into pancreatic fistula group (63 cases) and non-pancreatic fistula group (30 cases) . The preoperative data were compared between the two groups. Box plot and the receiver operating characteristic curve (ROC) were drawn. The area under the ROC curve (AUC) was calculated. The sensitivity and specificity of PCT, CRP, and WBC levels in predicting pancreatic fistula alone and jointly were calculated.Results:There were no statistically significant differences in the age, gender, presence or absence of diabetes, total bilirubin, preoperative albumin, surgical time, or intraoperative bleeding in the general information of the pancreatic fistula group and the non-pancreatic fistula group. The difference in index (BMI) was statistically significant. The value of PCT, CRP, and WBC before operation and the value of PCT on the first day after operation were not statistically significant between the two groups ( P=0.424, 0.819, 0.484, and 0.072, respectively) . The PCT values on the 3rd and 5th days after surgery, the values of CRP and WBC on the 1st, 3rd, and 5th days after surgery were all statistically significant (all P values were<0.05) . The area under the ROC curve was jointly predicted by the three at the 3rd and 5th days after operation (AUC=0.792, 0.812) , and the sensitivity (62.9%, 71.4%) and specificity (83.3%, 80%) were better than the three alone. Conclusion:PCT, CRP, and WBC values on the 1st, 3rd, and 5th days after surgery alone have certain limitations in predicting pancreatic fistula, and the combined prediction of the three is more valuable.
ABSTRACT
Objective To carry out a meta-analysis,in order to evaluate the effectiveness and safety of the duodenum-preserving pancreatic head resection (DPPHR) and pancreaticoduodenectomy (PD) or pylorus-preserving pancreaticoduodenectomy(PPPD) for surgical treatment of chronic pancreatitis.Methods Medline,EMBASE,Cochrane library and other medical databases were searched for the clinical trials (randomized controlled trials) of comparing DPPHR Versus PD/PPPD.A total of 5 clinical trials (8 references) met the inclusion criteria.The data were analyzed using the RevMan 5.3 software.Results The two methods don't have statistical differ ence in terms of operation time (P=0.007),postoperative morbidity (P=0.35) and mortality (P=0.18),pain relief(P=0.36),new onset of diabetes(P=0.11),exocrine insufficiency(P=0.18),short-term(P=0.14) and long-term(P=0.16) quality of life score,the length of hospital stay (P=0.69),and pancreatic fistula (P=0.78).Weight gain (P＜0.000 01) and occupational rehabilitation (P=0.03)were significantly improved in the DPPHR group.However,PD/PPPD group was associated with fewer readmission due to pancreatic diseases.Conclusions DPPHR offers more advantages with regard to the quality of life.However,it needs more high-quality clinical trials to verify the results.