The Related On Risk Factors And Treatment Of Pancreatic Fistula After Pancreaticojejunostomy

ObjectiveTo investigate the risk factors and management of pancreatic fistula after Pancreaticojejunostomy. Analysis the prevention and treatment of pancreatic fistula.,MethodsThe clinial data of120patients who underwent Pancreaticojejunostomy at our hospital from August1999to June2011were retrospectively analyzed. Ten factors which the perioperative period potentially affect the incidence of pancreatic fistula were analyzed with univariate and multivariate logistic regression model. According to gender, age, preoperative bilirubin level, preoperative albumin levels, pancreas, quality of a material, pancreatic tube diameter, whether the application growth inhibition change and enteral nutrition were divided into two groups; By the different methods of pancreatic bowel anastomosis, divided into the end to side pancreaticoje-junostomy group and side to side pancreaticoje-junostomy group; According to the processing of pancreatic bowel anastomotic methods are different, divided into continuous seam legal and Prolene line continuous seam legal two groups. Application SPSSl1.0statistical software for statistical data processing. Uniariate analysis according to situation choose chi-square Fisher and precise probability inspection, the inspection standards α=0.05. Statistically signi-ficant factors of Logistic regression analysis, confirmed independent risk factor.ResultsAll the120patients were pancreatic fistula in9cases, a rate of7.5%. The pancreatic intestinal end-to-side into the type of anastomosis in85cases, happen6cases of pancreatic fistula, pancreatic duct jejunum side-to-side anastomosis of the35patients, occurred in3cases of pancreatic fistula; Prolene line continuous seam legal in82cases, pancreatic fistula in2cases occur, the common thread of38cases of continuous suture, happened7cases of pancreatic fistula.The statistic results do single factor analysis shows that the occurrence of pancreatic fistula with sex, age, preoperative bilirubin level, preoperative albumin levels and pancreatic bowel way, with growth inhibition change and enteral nutrition application or not has no obvious relation with pancreatic texture, and pancreatic duct diameter and have obvious concern with method.ConclusionPancreatic duct diameter≤3mm Pancreaticojejunostomy consistent risk factor for postoperative pancreatic fistula occurred, the relative risk (RR) was7.48, pancreas texture soft also pancreaticojejunostomy postoperative pancreatic fistula, the risk factors, the relative risk(RR) of4.13,.Reasonable way of dealing with the pancreatic stump and select the appropriate agreement, which can effectively reduce the incidence of postoperative pancreatic fistula.Interrupted suture would increase the pancreatic fistula rate after Pancreaticojejunostomy Roux-en-Y surgery,continous suture with prolene to reduce the incidence of pancreatic fistula, and the operation is simple. The incidence of pancreatic fistula and postoperative treatment measures are also significant relationship between early postoperative somatostatin and enteral nutrition support of the application, may also reduce the pancreaticojejunostomy postoperative pancreatic fistula occurred.