The Risk Factors Analysis And Prevention Strategies Of Pancreatic Fistula After Laparoscopic Pancreaticoduodenectomy

Objective:To study the risk factors for postoperative pancreatic fistula(POPF)after Laparoscopic pancreaticoduodenectomy(LPD).Explore the efficacy of the Alternative Fistula Risk Score(a-FRS)in the assessment of POPF after LPD.Take appropriate preventive measures to reduce the occurrence of pancreatic fistula,and take appropriate methods to treat pancreatic fistula to provide certain insights and methods for the prevention and treatment of pancreatic fistula.Methods:For this study,the 105 patients who underwent LPD in the last 5 years in our hospital were retrospectively analyzed as the study population.Detailed 19 clinical data of patients in the perioperative period were collected by reviewing clinical data and referring to relevant literature.Based on the presence or absence of postoperative pancreatic fistula,the group was divided into pancreatic fistula and non-pancreatic fistula groups(refer to the 2016 International Pancreatic Fistula Research Organization definition for pancreatic fistula diagnosis criteria and grading).The nineteen clinical data were subjected to single factor analysis,and those that were statistically significant were subsequently subjected to logistic regression analysis to identify independent risk factors for pancreatic fistula.The sensitivity and specificity of a-FRS for predicting postoperative pancreatic fistula after LPD were analyzed by using the receiver operator characteristic curve(ROC).It was judged to be statistically significant at P<0.05.Results:There were 105 patients with routine LPD and 30 cases of POPF.(1)Perioperative clinical data were subject to single factor analysis between the pancreatic fistula group and the non-pancreatic fistula group.The results showed that age(t=2.708,P=0.008),BMI(t=8.220,P<0.001),intraoperative bleeding(Z=4.334,P<0.001),pancreatic duct diameter(X~2=14.655,P<0.001),pancreatic texture(X~2=7.000,P=0.008),pancreatic duct support duct type(X~2= 9.931,P=0.002),and lesion site(X~2=4.496,P=0.034),with statistically significant differences(P<0.05),suggesting that the above factors may be correlated with pancreatic fistula.(2)The above factors were subjected to multi-factor logistic regression analysis.It was found that high BMI(OR=7.157,95% CI: 2.303-22.238,P=0.001),soft pancreatic mass(OR=40.231,95% CI: 2.151-752.644,P=0.013),pancreatic duct diameter≤ 3 mm(OR=13.647,95% CI: 1.456-127.926,P=0.022),and high intraoperative bleeding(OR=1.013,95% CI: 1.004-1.022,P=0.003)were independent risk factors for POPF.A variably sized measurable pancreatic duct support tube(OR=0.084,95% CI: 0.008-0.861,P=0.037)placed intraoperatively was a protective factor for POPF.(3)According to ROC curve analysis,the a-FRS system had a sensitivity of 90.0% and a specificity of 72.0% for predicting clinically relevant pancreatic fistula after LPD,with an area under the curve of 0.88(95% CI:0.806-0.954).(4)22 cases of grade B pancreatic fistula occurred,of which 14 patients improved after conservative treatment,3 patients underwent interventional treatment for bleeding due to pancreatic fistula,and 5 patients underwent invasive treatment.There were 8 cases of grade C pancreatic fistula,of which 4patients underwent a 2nd operation and 4 patients had pancreatic fistula leading to organ failure.Conclusion:1.It is found that perioperative patient age,BMI,pancreatic texture,pancreatic duct diameter,lesion site,intraoperative bleeding,and pancreatic duct support duct type may influence the occurrence of POPF.In which high BMI,soft pancreas,pancreatic duct diameter ≤ 3 mm,and high intraoperative bleeding were independent risk factors for postoperative pancreatic fistula,and intraoperative placement of variable diameter measurable pancreatic duct was a protective factor for POPF.2.There is some clinical value of a-FRS scoring system in predicting pancreatic fistula after LPD,which can help us to take early measures to prevent pancreatic fistula.3.Following the occurrence of pancreatic fistula,we should choose conservative,invasive or surgical treatment in a timely manner,depending on the patient’s condition.The adequate unobstructed drainage is the basis for the treatment of grade B pancreatic fistula,and most grade B pancreatic fistula may prevent conversion into a grade C pancreatic fistula.Early detection and treatment should be done to prevent further deterioration of the condition.