Analysis Of Risk Factors Of Duodenal Stump Fistula After Gastric Operation

Background and Purpose:Duodenal stump fistula(DSF)is one of the most serious complications occurring early after gastric surgery,due to low incidence and relatively few studies,cases of gastric postoperative DSF complications were analyzed statistically for the purpose of further understanding related risk factors of their occurrence.In order to provide effective intervention measures for clinical workers.Methods:All the cases in this study were from the Department of Gastrocolorectal Surgery,General Surgery Center,The First Hospital of Jilin University.Clinical data of patients who underwent radical gastrectomy or subtotal gastrectomy with duodenal stump remaining during January 2019 to December 2022 were collected and retrospectively analyzed.The cases with postoperative DSF were selected as the case group,and 10 cases without DSF were randomly selected for each case as the control group.Nested case-control study was conducted on the related influencing factors of DSF occurrence.SPSS26.0 software was used for statistical analysis,and univariate and multivariate Logistic regression analysis was used for the related variables.Results:A total of 3229 cases receiving radical gastrectomy or subtotal gastrectomy were collected under the conditions of excluding proximal gastrectomy,partial gastrectomy,Billroth I anastomosis,simple gastrointestinal anastomosis and gastric operation history,among which 33 cases developed DSF.the total incidence of DSF was about1%.According to the nested case-control study method,33 DSF cases were randomly selected as control group at a ratio of 1:10.Univariate analysis showed that there were13 risk factors related to the occurrence of DSF,which were:The Nutrional risk score2002 ≥5 points,ASA grade ≥III,preoperative serum albumin < 30g/L,complicated with hypertension,heart disease,cirrhosis,preoperative chemotherapy,laparoscopic surgery,distal gastrectomy,malignant tumor,emergency surgery,operative time ≥3.5hours and intraoperative bleeding ≥100ml,all of which were statistically significant(P< 0.05).Multivariate Logistic regression analysis of the above variables showed that:Preoperative serum albumin < 30g/L(P=0.003),patients with cirrhosis(P=0.004),hypertension(P=0.015),preoperative chemotherapy(P=0.018),operation time ≥3.5h(P=0.001),emergency surgery(P=0.049)were independent risk factors for DSF.Conclusion:Complications of DSF after gastric surgery are associated with multiple factors,among which preoperative serum albumin < 30g/L,cirrhosis,hypertension,preoperative chemotherapy,emergency surgery and operation time ≥3.5 hours are independent risk factors for DSF.