Study On Risk Factors Of Complications After Pancreaticoduodenectomy

Objective : To study the risk factors associated with pancreaticoduodenectomy(PD)after periampullary carcinoma(PAC)patients undergoing pancreaticoduodenectomy(PD),and provide a reference for better prevention and treatment of postoperative complications after PD.Methods:The general clinical data of 95 patients with PAC who underwent PD surgery at the Hepatobiliary,Pancreas and Spleen Surgery Department of the Affiliated Tumor Hospital of Guangxi Medical University from January 2003 to October 2015 were collected,and the occurrence of common postoperative complications was counted.All the subjects were grouped according to the occurrence of complications.The chi-square test or fisher’s exact probability method were used to compare the clinical data of the two groups of patients,and binary logistic regression analysis was used to explore the risk factors related to complications after PD.Results : 1.The incidence of postoperative complications of PD(complication grade Clavien-Dindo-Ⅰ or higher)is 56.8%;the main complications are from high to low according to the incidence,followed by intra-abdominal infection(31.5%)and pancreatic fistula(25.2 %),postoperative wound infection(7.3%),delayed gastric emptying(5.2%),postoperative bleeding(5.2%),biliary fistula(3.15%),lung infection(1.05%),anastomotic leakage(1.05%)),lymphatic fistula(1.05%).2.The patients were divided into two groups according to whether they had Clavien-Dindo-Ⅰ or above complications after PD operation,and the general clinical data of the two groups were compared respectively.The results were the total serum bilirubin levels of the two groups,There are differences in NRS2002 scores and BMI values,and the differences are statistically significant(all P values<0.05);multivariate logistic regression analysis shows: total bilirubin ≥171 umol/L,NRS2002 score≥3,BMI <18.5 kg/ m2 is a relevant risk factor for postoperative complications of PD,and the correlations are statistically significant(all P values<0.05).3.The patients were divided into two groups based on whether they had intra-abdominal infection after PD operation.The general clinical data of the two groups were compared.The results showed that the total serum bilirubin level,NRS2002 score,and BMI value of the two groups existed.The differences were statistically significant(all P values<0.05);multivariate logistic regression analysis showed that total bilirubin ≥171 umol/L,NRS2002 score ≥3,and BMI<18.5 kg/m2 were intra-abdominal after PD The risk factors associated with infection were statistically significant(all P values<0.05).4.The patients were divided into two groups based on whether there was pancreatic fistula after PD operation.The general clinical data of the two groups were compared.The results showed that the NRS2002 scores and BMI values of the two groups were different,and the differences were statistically significant.(All P values <0.05);multivariate logistic regression analysis showed that: NRS2002 score ≥3,BMI<18.5 kg/m2 are related risk factors for pancreatic fistula after PD,and the correlations are statistically significant(all P values< 0.05).Conclusion:The incidence of complications after PD is relatively high.Among them,intra-abdominal infection and pancreatic fistula are the two most common complications after PD.Serum total bilirubin level ≥171 umol/L,NRS2002 score ≥3,BMI <18.5 kg/m2 are related risk factors for complications after PD.Serum total bilirubin level ≥171 umol/L,NRS2002 ≥3,BMI <18.5kg/m2 are related risk factors for intra-abdominal infection after PD.NRS2002 score ≥3 and BMI <18.5 kg/m2 are related risk factors for pancreatic fistula after PD.