Analysis Of Factors Between Pancreaticojejunostomy And Pancreatic Leakage After Pancreaticoduodenectomy

ObjectiveTo analyze the factors between pancreaticojejunostomy and pancreasticleakage after pancreaticoduodenectomy (PD)and explore whetherbingding pancreaticojejunostomy(BPJ)can reduce the risk of pancreaticleakage.MethodsOne hundred thirty-seven patients receiving pancreaticoduodenectomyin our hospital between January 2000 and December 2007 werereviewed.7 preoperative and 6 intraoperative risk factors for pancreaticleakage were analyzed to find out the relationship between anastomictechnicques and pancreatic leakage by the means of univariate analysisand multivariate logistic regression analysis.Assessment of pancreatic leakage :①Pancreaticojejunal anastomoticleakage was found in postoperative patients of receiving pancreaticojejunostomyover 3-10 days and leaking pancreatic juice from ductuspancreaticus over 7 days.②Elevated degree of amylolytic enzymeconcentration from drainage tube exceeded 3 times of serum amylase degree.③Liquid quantum from drainage tube exceeded 50ml per day.④Andit had one or more than one of following clinical manifestations: peritonealirritation sign; bellyache in progress；T>38.5℃,WBC>15×109/L orradiology confirming ,or pancreatic leakage or stoma to split is diagnosedin operation again.Results1.Of the 137 patients,the incidence rate of overall complicationwere 32.1%(44/137),Pancreaticojejunal anastomotic leakage was found in 22 out of the 137 patients (16.1%) (22/137) , 3.7 % ( 1/ 27) of the patientsundergoing bingding pancreasticojejunostomy (BPJ) and 19.1% (21/ 110) ofthose receiving pancreaticojejunostomy.2.Univariate analysis revealed that pancreaticojejunostomy, pancreaticduct size and texture of the remnant pancreas were identified assignificant risk factots for pancreatic leakage. Pancreatic duct size andtexture of the remnant pancreas were turned out to be independent riskfactors (P:0.004 and 0.047,OR:4.654 and 2.919)by means of multivariatelogistic regression analysis.ConclusionsPancreaticojejunostomy, pancreatic duct size and texture of remnantpancreas are risk factors for pancreatic leakage after pancreaticcoduodenectomy.Bingding pancreaticojejunostomy(BPJ) , as a safe anduseful anastomotic technique , can reduce pancreatic leakage rate afterpancreaticoduodenectomy.