Analysis Of Risk Factors Of Pancreatic Fistula After Laparoscopic Pancreaticoduodenectomy

Objective:laparoscopic pancreaticoduodenectomy has become a standard method for radical cure of benign and malignant tumors of pancreas and ampulla,but as the most serious complication,postoperative pancreatic fistula is still at a high level.The purpose of this study was to analyze the perioperative risk factors of pancreatic fistula after laparoscopic pancreaticoduodenectomy.Methods:105 patients who underwent laparoscopic pancreaticoduodenectomy were divided into two groups according to the occurrence of pancreatic fistula.Chi-square test was used to classify variables.The continuous variables accord with the normal distribution by t-test,and the data that do not accord with the normal distribution by U-test.P < 0.05 means that the difference is statistically significant.For significant single factor,logistic regression analysis was used for multivariate analysis.To determine the independent risk factors of pancreatic fistula after laparoscopic pancreaticoduodenectomy.Results: a total of 105 patients were included in this study,of which24 patients had pancreatic fistula,accounting for 22.9%,including 19 cases of grade B fistula and 5 cases of 18.1% grade C fistula,accounting for 4.8%.Two patients died during the perioperative period,with a mortality rate of 1.9%,all occurred in the pancreatic fistula group,and all died of postoperative bleeding due to grade C pancreatic leakage.There were significant differences in BMI,preoperative bilirubin,pancreatic duct diameter and pancreatic texture between the two groups,suggesting that they were related factors of postoperative pancreatic fistula in patients with LPD.Preoperative bilirubin ≥ 171 μ mol / L,BMI≥ 25 μ mol / m 2,pancreatic duct diameter ≤ 3 μ mol / L and soft ratio of pancreatic texture in pancreatic fistula group were significantly higher than those in non-pancreatic fistula group,which were related risk factors of postoperative pancreatic fistula.The results of multivariate logistic regression analysis showed that soft pancreatic texture and pancreatic duct ≤ 3 diameter were independent risk factors for postoperative pancreatic fistula.Conclusion:（1）BMI,bilirubin within one week before operation,pancreatic texture and pancreatic duct diameter may be related to pancreatic fistula after laparoscopic pancreaticoduodenectomy.（2）BMI ≥ 25 μ mol / m 2,bilirubin ≥ 171 μ mol / L one week before operation,soft texture of pancreas and diameter of pancreatic duct ≤ 3mm were independent risk factors for pancreatic fistula after LPD.（3）Laparoscopic pancreaticoduodenectomy should pay attention to the patients with soft pancreas,pancreatic duct diameter ≤ 3mm,BMI ≥ 25 °/ m 2,prepare for postoperative pancreatic fistula,early detection and treatment,reduce the severity of pancreatic fistula,delay the progression of pancreatic fistula,and reduce the level of bilirubin before operation,which may reduce the incidence of postoperative pancreatic fistula.