イズモ　ワタル   Izumo Wataru   出雲　渉    所属   医学部 医学科（東京女子医科大学病院）    職種   非常勤講師
論文種別	原著
言語種別	英語
査読の有無	査読あり
表題	Evaluation of preoperative risk factors for postpancreatectomy hemorrhage.
掲載誌名	正式名：Langenbeck's archives of surgery 略　 称：Langenbecks Arch Surg ISSNコード：14352451/14352443
巻・号・頁	pp.967-974
著者・共著者	Izumo Wataru, Higuchi Ryota, Yazawa Takehisa, Uemura Shuichiro, Shiihara Masahiro, Yamamoto Masakazu
担当区分	筆頭著者
発行年月	2019/10
概要	PURPOSE:To investigate the risk factors for post-pancreatectomy hemorrhage (PPH).METHODS:The incidence, outcome, and risk factors for PPH were evaluated in 1169 patients who underwent pancreatectomy.RESULTS:The incidence and mortality rates of PPH were 3% and 11% in all pancreatectomies, 4% and 11% in pancreatoduodenectomy, 1% and 20% in distal pancreatectomy, and 3% and 0% in total pancreatectomy, respectively. Male sex [odds ratio (OR) 2.32], body mass index (BMI) ≥ 25 kg/m2 (OR 3.70), absence of diabetes mellitus (DM; HbA1c ≤ 6.2%; OR 3.62), and pancreatoduodenectomy (OR 3.06) were risk factors for PPH after all pancreatectomies. The PPH incidence was 0%, 1%, 2%, 6%, and 20% in patients with risk scores of 0 (n = 65), 1 (n = 325), 2 (n = 455), 3 (n = 299), and 4 (n = 25), respectively. The differences between risk-score groups 0-2 (2%) and 3-4 (7%) were significant (P < 0.05, OR 4.7). In patients who had undergone pancreatoduodenectomy, postoperative pancreatic fistula (POPF; OR 31.7) and absence of DM (OR 3.45) were risk factors for PPH. There was no significant association between POPF and PPH after distal pancreatectomy (P = 0.28). The incidence of POPF post-pancreatoduodenectomy was 20%. BMI ≥ 25 kg/m2 (OR 3.17), serum albumin < 3.5 g/dl (OR 1.77), absence of DM (OR 1.75), distal extrahepatic bile duct carcinoma (OR 4.05), and carcinoma of the papilla of Vater (OR 5.19) were risk factors for POPF post-pancreatoduodenectomy.CONCLUSION:Our study clarified the preoperative risk factors for PPH and recommends using a risk scoring system that includes "absence of DM" for predicting PPH.
DOI	10.1007/s00423-019-01830-w
PMID	31650216