Clinical Diagnosis And Treatment On Postoperative Pancreatic Fistula With Radical Resection Of Gastric Cancer.

Background and purposeGastric cancer remains one of the most common gastrointestinal carcinoma. In spite of the worldwide decreasing tendency of the incidence,the incidence of gastric cancer remain the third all of the malignant tumors,and the morbidity is first with the male 30.1/10000,female 13.8/10000.Surgical resection of primary tumors is the only curative treatment for upper gastrointestinal cancers.In the process of radical gastrectomy,the tumors invaded the pancreas or incorrect operation may lead to pancreatic fistula.Pancreatic fistula may cause bleeding, abdominal infection,reoperation,prolonged hospitalized course and increased hospitalized expense.So Research on Prevention and treatment of pancreatic fistula is important in abdominal surgery.The study retrospectively reviewed the case of 670 patients with radical gastrectomy,explored the diagnosis,treatment, Influencing Factors and prognosis of postoperative pancreatic fistula.Research Method1.Research Objectcases of 670 patients with radical gastrectomy during 2004.1.1 to 2008.9.1 in Huashan Hospital,Shanghai(except the cases of palliative gastrectomy and gastrectomy combined with part resection of pancreas.)2.Observation IndexGeneral Information:Gender,Age,and preoperative evaluation(nutrition status, history of abdominal operation,diabetes)Surgical index:Operation mode,operation time,the relation between gastric tumors and pancreas.Pathological stage:pathological classification,pTNM stages(The UICC TNM staging classification,1997)Postoperative index:The dynamic changes of drainage flow,the amylase value of drainage fluid.Occurrence time and remission time of pancreatic fistula.The treatment method and prognosis of pancreatic fistula, other postoperative complications.3.Statistical AnalysisStatistical software SPSS11.5 for the statistics and analysis of the 670 cases.The difference has statistical significance if P＜0.05.Results41 postoperative pancreatic fistula cases(6.12%),including 21 clinical pancreatic fistula cases(3.13%),and 20 biochemical pancreatic fistula cases (2.99%).All the 41 patients are treated conservatively,and the results were satisfactory.The average remission time was 16.05±11.93d.The patients was given combined therapy including:Keeping abdominal drainage unobstructed, fasting and gastrointestinal decompression,fluid and electrolyte supplement, inhibiting pancreatic enzyme secretion drug(such as ulinastatin,somatostatin or stilamin),using broad-spectrum antibiotic or adjusting Antibiotics According to the result of bacteria culture and drug sensitive test,nutritional support and so on.The pancreas involved by gastric tumor is the most important high risk factor of pancreatic fistula(OR=4.064,95%CI 1.987-8.315,P＜0.001),The aged(OR=3.199,95%CI 1.501-6.821,P=0.O03),advanced tumor and radical total gastrectomy(OR=1.772,95%CI 0.868-3.619,P=0.116) is the related high risk factor of pancreatic fistula.Extended lymphadenectomy,nutrition status and history of abdominal operation didn't improve the risk of pancreatic fistula.The amylase value of drainage fluid can be used for diagnosing pancreatic fistula,and the sensibility was 58.8%,the specificity was 92.6%on the 1st postoperative day.ConclusionBy increased amylase value of drained intra—abdominal fluid after radical resection of gastric cancer,Pancreatic fistula may be diagnosed in an early stage effectively.Keeping abdominal drainage unobstructed,using broad-spectrum antibiotic and inhibiting pancreatic enzyme secretion can cure pancreatic fistula effectively.