Study On Clinical Characteristics And Influencing Factors Of Clinically Related Pancreatic Fistula After Pancreaticoduodenectomy

Background and objectivePancreaticoduodenectomy(PD)is the main treatment for carcinoma of pancreatic head,ampullary and duodenum.Clinically relevant pancreatic fistula(CR-POPF)is one of the most serious postoperative complications,which can also lead to bleeding,surgical site infection and early death.At present,there are still some controversies about the risk factors and secondary surgical treatment of pancreatic fistula.Therefore,the purpose of this study is to explore the clinical characteristics and influencing factors of postoperative pancreaticoduodenal pancreatic fistula,so as to guide the prevention and treatment measures of CR-POPF.The second is to study the clinical characteristics and treatment strategies of grade C pancreatic fistula,evaluate the results of different surgical procedures,and discuss the risk factors that may lead to death,so as to select patients at risk of rescue failure.MethodPartⅠ Clinical characteristics and influencing factors of clinically related pancreatic fistula after pancreaticoduodenectomyContinuous cases of pancreaticoduodenectomy in our hospital from 2017 to 2019 were retrospectively analyzed.According to the definition of 2016 International Study Group of Pancreatic Surgery(ISGPS),according to the presence of the grade B or C pancreatic fistula,the perioperative data were analyzed to explore the independent risk factors of CR-POPF.PartⅡ Clinical characteristics and influencing factors of the grade C pancreatic fistulaRetrospective analysis of the secondary surgical cases of the grade C pancreatic fistula after pancreaticoduodenectomy in 2010-2019.Perioperative data and treatment outcomes were compared between groups.ResultPartⅠ Clinical characteristics and influencing factors of clinically related pancreatic fistula after pancreaticoduodenectomyOut of 1083 patients,172(15.9%)developed grade B/C POPF and 381(35.2%)had asymptomatic postoperative biochemical fistulas.Four predictors were strongly associated with POPF: high BMI>22kg/m2(odds ratio [OR] 1.959,95% CI 1.359-2.822,p=0.001);soft pancreatic texture(OR 2.344,95% CI 1.570-3.498,p=0.001);fine pancreatic duct(OR1.980,95% CI 1.115-3.337,p=0.010);and high-risk pathology(OR 1.939,95% CI1.339-2.809,p=0.001).PartⅡ Clinical characteristics and influencing factors of the grade C pancreatic fistulaOut of 30 patients,simple drainage of the pancreatic anastomosis,external wirsungostomy and jejunostomy decompression drainage were performed in 11,9,and 10 cases,respectively.The mortality rate for simple drainage of the pancreatic anastomosis was 27.3%,compared with 22.2% for external wirsungostomy(p = 1.0)and 30% for jejunostomy decompression drainage(p = 1.0).On univariate analysis,the potential factors predictive of mortality after relaparotomy for pancreatic fistula were organ failure prior to reoperation(p = 0.048).ConclusionIndependent risk factors for CR-POPF after pancreaticoduodenectomy were high BMI,soft pancreatic texture,fine pancreatic tube diameter,and high-risk pathological types.Through these factors to simply predict and evaluate the occurrence of postoperative CR-POPF,to proactively prevent and treat pancreatic fistula,thus improving patient outcomes.There was no statistical difference in the treatment results of different surgical treatment options after grade C pancreatic fistula.Except for specific cases,appropriate retained residual pancreatic surgery was recommended according to experience and intraoperative conditions.The presence of organ failure prior to secondary surgery for grade C pancreatic fistula may be a potential risk factor for predicting death.The occurrence of postoperative pancreatic fistula should be timely intervention,and organ failure should be avoided whenever possible.