Clinical Efficacy Of A Novel Pancreaticojejunostomy Technique In Preventing Postoperative Pancreatic Fistula And Pancreatic Fistula-associated Hemorrhage In Pancreaticoduodenectomy

Objective:Pancreaticoduodenectomy has the characteristics of many operation steps,cumbersome anastomosis process,long operation time,difficulty and high incidence rate of postoperative complications.Postoperative pancreatic fistula,as one of the most common complications of this procedure,will cause pancreatic fistula-associated hemorrhage and seriously threaten the lives of patients.In recent years,a number of studies have shown that pancreaticojejunostomy is an independent risk factor for postoperative pancreatic fistula,so pancreaticojejunostomy has become a hot spot in pancreatic surgery.In this study,we improved the existing pancreaticojejunostomy,proposed a new pancreaticojejunal reconstruction method,and applied in pancreaticoduodenectomy,in order to verify the efficacy and safety of this new pancreaticojejunostomy technique in preventing postoperative pancreatic fistula and pancreatic fistula-associated hemorrhage.Methods:This is a single-center retrospective cohort study.3 00 cases of pancreaticoduodenectomy performed in the Pancreatic Center of Shengjing Hospital of China Medical University from January 2016 to June 2020 were retrospectively collected,The patients were divided into test group(novel pancreaticojejunostomy)and control group(traditional pancreaticojejunostomy)according to the pancreaticojejunostomy method used during operation.Measurement data were compared between the two groups using the t-test or Mann-Whitney U test.Enumeration data were compared between the two groups using χ2 test or Fisher’s exact test.Multivariate logistic regression analysis was used to investigate the independent risk factors of POPF and Postpancreatectomy hemorrhage.Results:A total of 94 cases were finally collected in this study,including 44 cases in the test group(novel pancreaticojejunostomy)and 50 cases in the control group(traditional pancreaticojejunostomy).The incidence of postoperative pancreatic fistula in the test group was(1/43,2.30%),the duration of postoperative abdominal drainage retention was 12(10,14)d,and the number of postoperative hospital days was 16(14,24.5)d.The incidence of postoperative pancreatic fistula in the control group was(9/41,18%),the duration of postoperative abdominal drainage retention was 15(12,24)d,and the number of postoperative hospital days was 20.5(16,33)d.The test group was better than the control group in terms of postoperative pancreatic fistula(P=0.033),retention time of abdominal drainage(P=0.001),days of postoperative hospitalization(P=0.018),and pancreatic fistula-related bleeding.After logistic regression analysis,the mode of pancreaticenteric anastomosis was confirmed as an influencing factor for POPFConclusion:The new pancreaticojejunostomy can effectively reduce the incidence of postoperative pancreatic fistula and pancreatic fistula-related hemorrhage,reduce the cost of hospitalization,shorten the postoperative hospital stay,and in terms of postoperative biliary fistula,gastric tube indwelling time,gastrointestinal peristalsis disorder,abdominal infection,and the second operation,there is no significant difference between the new pancreaticojejunostomy and the traditional pancreaticojejunostomy,indicating that the new pancreaticojejunostomy has equivalent safety and feasibility and is a safe,effective and worthy of promotion of pancreaticojejunostomy.