Research Of Risk Factors, Predictors And Prevention Of Pancreatic Fistula After Pancreatoduodenectomy

Objective: Pancreatic fistula remains a potentially fatal complication.In order to identify risk factors and predictors of pancreatic fistula formation, and ways to prevent it.Methods: The relation between pancreatic fistula formation and various clinical parameters was investigated in 50 patients who underwent PD from 1990 to2010 in our hospital. Statistical significance was assessed byχ2 -test, t-test and regression analysis using SPSS11.5 software. P values< 0.05 were considered statistically significant.Results: The incidence of pancreatic fistula in these patients was 28%. Multivariate analysis identified three independent factors correlated with the occurrence of pancreatic fistula: (1) absence of fibrotic texture of the pancreas examined intraoperatively (relative risk [RR], 1.5; 95% confidence interval [CI],1.2–2.0; P = 0.01); (2) serum amylase concentration greater than 201 U/l (1.70 times the normal upper limit) on the first postoperative day (RR, 2.3; 95% CI, 1.0–5.7; P = 0.01); and (3)not having early postoperative enteral nutrition (RR, 3.1; 95%CI, 1.2–9.0; P = 0.004).Conclusion: Soft texture of the pancreas and increased serum amylase the day after PD are both risk factors with predictive value for pancreatic fistula. The incidence of fistula formation is reduced by early postoperative enteral nutrition...