| Part ? Risk Factors in Postpancreaticoduodenectomy Hemorrhage:A Meta-analysisObjective The development and application of pancreaticoduodenectomy(PD)were summarized and analyzed retrospectively.The risk factors of post pancreaticoduodenectomy hemorrhage(PPDH)were analyzed in this meta-analysis,which provided theoretical basis for the prevention and treatment of PPDH during perioperative period.Data and methods We collected relevant studies of risk factors of PPDH before December 2018 via searching MEDLINE,PUBMED,Cochrane Library,EMBASE,CNKI,WanFang database and other resources.Two researchers independently extracted the data from the included studies and evaluated the quality according to the Newcastle-Ottawa Scale(NOS)scale.When disagreement occurred,a third researcher joined to discuss and solved the problem.In this study,RevMan 5.3 and STATA were used in this meta-analysis.The heterogeneity of the research is included in the analysis to ensure the reliability of this meta-analysis.Results According to the screened criteria,36 articles were included in this study.The results showed that diabetes,preoperative level of alanine aminotransferase and properties of tumor were not significantly correlated with the occurrence of PPDH(P>0.05).The incidence of PPDH in aged patients was higher than that in control group(SMD 0.20,95%CI:0.07-0.33,P=0.002),in male patients was higher than that in female patients(OR 1.48,95%CI:1.26-1.74,P<0.001),in hyperpietic patients was higher than that in non-hyperpietic patients(OR 1.29,95%CI:1.02-1.63,P=0.033),in patients with high preoperative total bilirubin was higher than that in normal patients(SMD 0.37,95%CI:0.19-0.54,P<0.001),in patients undergoing longer duration of operation was higher than that in control group(SMD 0.18,95%CI:0.03-0.33,P=0.020),in patients with more blood loss(OR 0.43,95%CI:0.14-0.72,P=0.004),in patients with larger tumors(SMD 0.42,95%CI:0.17-0.66,P=0.001),in patients with pancreatic fistula after operation was higher than in control group(OR 5.71,95%CI:4.22-7.72,P<0.001)and in abdominal infection group was higher than that of control group(OR 4.29,95%CI:3.48-5.29,P<0.001).Conclusion The results showed that age,gender,hypertension,preoperative total bilirubin level,duration of operation,blood loss,tumor size,pancreatic fistula and abdominal infection were correlated with PPDH.There was no significant correlation between PPDH and diabetes,preoperative level of alanine aminotransferase,properties of tumor.Part II Clinical Analyses of Delayed Postpancreatectomy Intraperitoneal HemorrhageObjective To investigate the risk factors of delayed postpancreatectomy intraperitoneal hemorrhage.Methods The data of 970 patients who received pancreatectomy from Dec 2006 to Dec 2018 in the First Affiliated Hospital of Soochow University were retrospectively analyzed,the risk factors of delayed postpancreatectomy intraperitoneal hemorrhage were statistics analyzed with Logistic regression model.Results 51 of the 970 patients who received pancreatectomy occurred delayed postpancreatectomy intraperitoneal hemorrhage and 23 of them died.Reflux,hypoalbuminemia,high lenvel of CA199,lapraroscopic or not,operation time,the type of pancreatectomy,with or without pancreatic anastomosis,the loss of blood,incision infection,pancreatic fistula,bile leakage,intraabdominal infection,alimentary tract leakage,delayed gastric empty and gastrointestinal bleeding are the risk factors.In addition,pancreatic fistula was an independent risk factor of delayed postpancreatectomy hemorrhage,delayed postpancreatectomy hemorrhage was closely related to laparoscopy.Conclusion Prevention of pancreatic fistula,avoiding of laparoscopy are helpful to reduce the occurrence of delayed postpancreatectomy intraperitoneal hemorrhage. |
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