Study On Postoperative Pancreatic Fistula Causeing By Different Pancreaticoduodenectomy Anastomotic Methods

Objective：To explore application of different anastomotic methods of the pancreaticstump and the effect on postoperative pancreatic fistula in pancreaticoduodenectomy.Methods: Retrospective analysis the clinical data of the43cases patients whowere operated pancreaticoduodenectomy during January2008to December2011inJiangxi tumor hospital and divided into bundled pancreaticojejunostomy group11cases, pancreatic intestinal end-to-side anastomosis group23cases, and bundledpancreaticogastrostomy group9cases according to the different anastomoticmethods of the pancreatic stump.Compare the pancreatic fistula rate, operation time,intraoperative blood loss and average days of hospitalization, amylase levels ofabdominal cavity drainage liquid and gastric juice between each group.Results: The results were drawed from successful pancreaticoduodenectomy.(1) Three average operation time: the bundled pancreaticojejunostomy grap was4.2±0.7hours, the pancreatic intestinal end-to-side anastomosis group was3.5±0.4h,the bundled pancreaticogastrostomy group was5.1±0.5h, and p>0.05. There was nosignificant differences in these groups;(2) Three average amount of blood loss: the bundled pancreaticojejunostomy grapwas534±26.3ml, the pancreatic intestinal end-to-side anastomosis group was410±18.1ml,the bundled pancreaticogastrostomy group was567±19.5ml, andp>0.05. There was no significant differences in these groups;(3). Three the amylase levels of abdominal cavity drainage liquid on first day: thebundled pancreaticojejunostomy grap was37±0.7iu/L, the pancreatic intestinalend-to-side anastomosis group was50±0.9iu/L, the bundled pancreaticogastrostomygroup was29±0.3iu/L, and p>0.05. There was no significant differences in thesegroups;(4). Three the amylase levels of abdominal cavity drainage liquid on seven day: thebundled pancreaticojejunostomy grap was7±0.2iu/L, the pancreatic intestinalend-to-side anastomosis group was9±0.3iu/L, the bundled pancreaticogastrostomygroup was5±1.1iu/L, and p>0.05. There was no significant differences in these groups;(5) Three the amylase levels of gastric juice on first day: the bundledpancreaticojejunostomy grap was9±0.6iu/L, the pancreatic intestinal end-to-sideanastomosis group was12±0.3iu/L, the bundled pancreaticogastrostomy groupwas2234±1.1iu/L, and p＜0.01. There was significant differences in these groups;(6). Three the average days of hospitalization: the bundled pancreaticojejunostomygrap was21±3.2days, the pancreatic intestinal end-to-side anastomosis group was23±2.4days, the bundled pancreaticogastrostomy group was23±2.4days, andp>0.05. There was no significant differences in these groups;(7). Three pancreatic fistula rate: the bundled pancreaticojejunostomy grap was9.09%, the pancreatic intestinal end-to-side anastomosis group was13%, thebundled pancreaticogastrostomy group was0%, and p>0.05. There was nosignificant differences in these groups;Among all patients there was4cases occurred postoperative pancreatic fistula(pancreatic fistula rate was10.7%), and1case died of complicated intra-abdominalinfections and multiple organ failure, the pancreatic fistula related mortality was2.4%(1/43).Conclusion: Because there was no significant differences in different anastomoticmethods of the pancreatic stump in pancreatic fistula rate, operation time,intraoperative blood loss and average days of hospitalization, amylase levels ofabdominal cavity drainage liquid and gastric juice. These methods have nodifferences in prevention of postoperative pancreatic fistula. The success rate of theoperation depend on more proficiency and surgical techniques. In order to achieve alow pancreatic fistula rate, we should choose a best method depending on specificcircumstances and improve our surgical experience for selecting the most skilledpancreatic stump anastomosis.