Прогнозирование панкреатической фистулы после панкреатодуоденальной резекции с помощью компьютерной томографии

Цель исследования: выявить и оценить возможности прогнозирования панкреатической фистулы после панкреатодуоденальной резекции на основании данных предоперационной компьютерной томографии (КТ).

Материал и методы. В 2005 г. Международная рабочая группа по изучению панкреатических фистул (International Study Group on Pancreatic Fistula, ISGPF) разработала критерии градации панкреатических фистул на бессимптомные биохимические (Grade A) и клинически значимые (Grade B и С), требующие терапевтической (Grade A) или хирургической коррекции (Grade B и С). Данная классификация стала общепринятой и широко используется. Проведен анализ литературы, при котором учитывались только оригинальные англоязычные публикации после 2005 г, которые описывали возможности предоперационной количественной оценки плотности поджелудочной железы (ПЖ) с помощью КТ, а данные КТ сопоставлялись с результатами гистологического исследования ткани ПЖ. Работы с малыми выборками (<10 пациентов) были исключены из анализа.

Результаты. Критериям включения соответствовали 3 статьи, описывающие возможности КТ для оценки степени фиброза и жировой инфильтрации паренхимы ПЖ, в качестве факторов риска панкреатической фистулы. Выявлена статистически достоверная зависимость данных показателей и риска панкреатической фистулы.

Заключение. Современные возможности Кт позволяют объективно судить о риске развития панкреатической фистулы и предоставляют хирургам возможность подобрать наиболее подходящую периоперационную тактику ведения пациента. Прогнозирование риска панкреатической фистулы и формирование гомогенных групп для клинических исследований позволят получать более достоверные результаты при анализе данных даже из разных источников, что, несомненно, повысит качество проводимых исследований.

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