| Objective: To investigate the influence of preoperative and intraoperative factors on pancreatic fistula,biliary fistula,incision infection,gastroparesis syndrome and bleeding after pancreatoduodenectomy(PD)in patients with pancreatic head adenocarcinoma,and to evaluate how to effectively control preoperative and intraoperative factors to avoid postoperative complications.Method: The clinical data of 125 patients with pancreatic head adenocarcinoma who underwent standard PD from January 2018 to January 2022 in the Department of Hepatobiliary and Pancreatic Surgery,Second Affiliated Hospital of Medical University and were diagnosed as pancreatic ductal adenocarcinoma by postoperative pathological examination were retrospectively analyzed.There were 74 males and 51 females,aged from 33 to 75 years(mean 54.6 years).Postoperative pathological diagnosis of pancreatic ductal adenocarcinoma was undifferentiated in 1 case(accounting for 0.8%),poorly differentiated in 1 case(accounting for 0.8%),moderately differentiated in 112 cases(accounting for 89.6%),moderately differentiated in 7 cases(accounting for 5.6%),moderately differentiated + infiltrated in 2 cases(accounting for 1.6%),and moderately differentiated in 2 cases(accounting for 1.6%).The measurement data were transformed into counting data and expressed by frequency,and then the chi-square test was used for univariate analysis.Logistic regression analysis was performed for the influencing factors with statistically significant analysis results.The area under the receiver operating characteristic curve was used to evaluate the predictive value of preoperative body mass index,blood glucose and intraoperative operation time for postoperative complications of PD.The predictive value of>0.9 was higher,0.7～0.9 was medium,and>0.5～<0.7 was lower.Results:1.35 cases(28%)of 125 patients had pancreatic fistula,including 14 cases(10.9%)of grade A pancreatic fistula,15 cases(12.0%)of grade B pancreatic fistula and 6 cases(4.8%)of grade C pancreatic fistula;Among them,11 cases were complicated with biliary fistula(accounting for 8.8%),10 cases were improved after adequate drainage,application of acid-inhibitory drugs,interventional surgery or secondary surgery,and 1 case died due to severe postoperative infection);28 cases(22.4%)were complicated with incision infection,24 cases were cured before one month after operation after adequate drainage,regular dressing change and application of antibiotics,and 6 cases were cured within 3 months after outpatient follow-up treatment.13 cases were complicated with gastroparesis syndrome(10.4%),13 cases were cured after proper exercise and promoting gastrointestinal peristalsis drug treatment);Postoperative bleeding occurred in 12 cases(9.6%),and 12 cases recovered after treatment.There were 4 reoperations and 1 death in hospital.2.Univariate analysis showed that body mass index>25 kg/m 2,preoperative diabetes mellitus,preoperative empty abdominal blood glucose> 6.1 mmol/L,preoperative γ-glutamyl transpeptidase>150 U/L,preoperative alkaline phosphatase> 3 423 U/L,preoperative carcinoembryonic antigen>3 ng/ml and intraoperative operation time>360 min were risk factors for postoperative complications such as pancreatic fistula and biliary fistula.Multivariate analysis showed that patients with BMI>25 kg/m2(P=0.003),6.1 ≤ preoperative fasting blood glucose <7mmol/L(P=0.003),preoperative fasting blood glucose ≥7mmol/L(P=0.019)were risk factors for pancreatic fistula after PD.6.1≤ preoperative fasting blood glucose < 7mmol/L(P=0.011),preoperative fasting blood glucose ≥7mmol/L(P=0.035)and operation time>360min(P=0.030)were risk factors for biliary fistula after PD.Body mass index>25 kg/m2(P=0.002)and preoperative fasting blood glucose ≥ 7mmol/L(P=0.029)were the risk factors for incisional infection after PD.BMI>25 kg/m2(P=0.040),preoperative fasting blood glucose <7mmol/L(P=0.045),preoperative fasting blood glucose ≥ 7mmol/L(P=0.007)were risk factors for gastroparesis syndrome after PD.Patients with a body mass index>25kg/m2(P=0.009),6.1 ≤ preoperative fasting blood glucose <7mmol/L(P=0.016),and preoperative fasting blood glucose ≥7mmol/L(P=0.018)were risk factors for bleeding after PD.Preoperative fasting blood glucose ≥ 6.1 mmol/L was a risk factor for pancreatic fistula,biliary fistula,incision infection,gastroparesis syndrome and postoperative bleeding after PD.3.Linear regression analysis showed that preoperative blood glucose level was positively correlated with postoperative pancreatic fistula,biliary fistula,incision infection,gastroparesis syndrome and postoperative bleeding(r =0.765,0.433,0.509,0.196,0.319,P <0.001,0.001,0.05,0.05,0.001,respectively).Body weight index had high predictive value for pancreatic fistula after pancreaticoduodenectomy(AUC = 0.988),and moderate predictive value for incision infection,gastroparesis syndrome and postoperative bleeding after PD(AUC = 0.888,0.845 and 0.758,respectively).Preoperative blood glucose had high predictive value for pancreatic fistula(AUC = 0.955),and moderate predictive value for biliary fistula,incision infection,gastroparesis syndrome and postoperative bleeding(AUC = 0.857,0.850,0.739,0.752).Operative time had little predictive value for biliary fistula after pancreaticoduodenectomy(AUC 0.644).Conclusions:1.The body mass index,diabetes history,fasting blood glucose,γ-glutamyl transpeptidase,alkaline phosphatase,carcinoembryonic antigen and operation time were the risk factors of postoperative complications.2.Preoperative fasting blood glucose can be used as a quantitative index of postoperative pancreatic fistula,biliary fistula,incision infection,gastroparesis,postoperative bleeding,and can predict the risk of complications after PD.3.The effective control of blood glucose,weight and scientific regulation of γ-glutamyl transpeptidase in the normal range before operation,the strict implementation of surgical operation specifications,sufficient understanding of surgical procedures,and continuous improvement of their own proficiency in surgery to shorten the operation time may effectively reduce the occurrence of postoperative complications of PD. |
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