| Objective:To explore the application of Clavien-Dindo grading system in the complications after laparoscopic pancreaticoduodenectomy and find out the relevant risk factors,so as to improve the safety of clinical patients during the perioperative period.Methods:Collect the general data of patients who underwent laparoscopic pancreaticoduodenectomy in the Second Department of Hepatobiliary Surgery,General Surgery Center,First Hospital of Jilin University from 2015 to 2021,including preoperative,intraoperative and postoperative data,screen out 793 patients,set the corresponding clinical data as a binary variable,and grade the severity of postoperative common complications according to the Clavien-Dindo grading system,X~2test and logistic binary regression analysis were used to explore the risk factors of postoperative complications and serious complications respectivelyResults:Of the 793 patients undergoing laparoscopic pancreatoduodenectomy,the median age was 60 years(IQR:52-66),including 442 males(55.7%)and 351 females(44.3%).The average total bilirubin was 94.23±85.67mmol/L,the average CA19-9was 154.05±197.59U/I,321(40.5%)patients underwent preoperative bile drainage,112(14.1%)patients hadcardiovasculardisease,103(13.0%)patients had diabetes,25(3.2%)patients had viral hepatitis,34(4.3%)patients were classified as ASA I,640(80.7%)patients were classified as ASA II,119(15.0%)patients were classified as ASA III.The median blood loss was 50(20-100)ml.The average operation time was191.02±66.90 minutes.424 cases(53.5%)had soft pancreas,135 cases(17.0%)had medium pancreas,and 234 cases(29.5%)had hard pancreas.408 patients(51.5%)had pancreatic duct diameter≤3mm,385 patients(48.5%)>3mm For the 793 patients undergoing laparoscopic pancreaticoduodenectomy,LPPC was reported in 260(32.8%)patients,including 169 cases of pancreatic fistula(21.3%),44 cases of biliary fistula(5.5%),17 cases of delayed gastric emptying(2.1%),55 cases of postoperative hemorrhage(6.9%),7 cases of intestinal fistula(0.8%),59 cases of abdominal infection(7.4%),and 28 cases of pulmonary complications(3.5%).All complications were classified into five grades(I-V grade)according to Clavien-Dindo grading system,of which 83 patients(31.9%)were grade I,91 patients(35.0%)were grade II,38 patients(14.6%)were grade IIIa,24 patients(9.2%)were grade IIIb,9 patients(3.5%)were grade IV,and 15 patients(5.8%)were grade V.86 patients(10.8%)experienced major complications(Grade III-V).The results of univariate and multivariate analysis showed that the independent risk factors for complications of laparoscopic pancreaticoduodenectomy were preoperative total bilirubin(P=0.029,OR=1.523),soft pancreatic texture(P<0.001,OR=1.399),male(P=0.038,OR=1.396)and intraoperative blood transfusion(P=0.033,OR=1.517).Preoperative total bilirubin(P=0.036,OR=1.906)and intraoperative blood transfusion(P=0.004,OR=2.123)were independently associated with postoperative complications.The influence of different bilirubin levels on the Clavien-Dindo classification of complications was statistically significant(P=0.036,OR=1.906).Conclusion:Preoperative total bilirubin,soft pancreas,male and intraoperative blood transfusion are independent risk factors for complications after laparoscopic pancreaticoduodenectomy.Preoperative total bilirubin is an independent risk factor for serious complications after laparoscopic pancreaticoduodenectomy.Clavien-Dindogradingsystem can be used as an effective tool to predict the risk related to major complications after surgery,and help guide the clinical management during perioperative period and the comparison of surgical effects in different hospitals. |
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