Analysis Study Of Risk Factors And Treatment On Postoperative Pancreatic Fistula With Radical Resection Of Gastric Cancer

Objective Gastric cancer is one of the most common cancers in china, and surgical resection is still its main therapy. Although the incidence of postoperative pancreatic fistula with radical resection of gastric cancer is low, it can lead to serious complications, such as bleeding, abdominal infection, anastomotic leakage and so on, which would not only increase hospitalization expenses but even result in death. Our study aims to find out risk factors of postoperative pancreatic fistula with radical resection of gastric cancer and its proper therapeutic measures.Methods1.Object:682cases with radical resection of gastric cancer in Provincial Hospital Affiliated to Shandong University from2006.1to2010.12were included in this study, except cases of palliative gastrectomy.2.Observation indexGeneral index:age, gender, VFA(Visceral Fat Area), diabetes mellitus, hyperlipidaemia, hypertension, nutrition status(hemoglobin, albumin) and abdominal reoperation.Surgical index:operation time, amount of bleeding in operation, pancreas capsule stripping, pancreas injury, lymph nodes dissection around pancreas, radical gastrectomy with spleen dissection and radical gastrectomy with spleen and partial pancreas dissection.Pathological index:tumor size, pathological category and pathological classification(pTNM).Postoperative index:the amylase value of drainage fluid on the first postoperative day. 3.Statistical analysis:statistical software SPSS15.0was used for data analysis. P<0.05presents significant difference.Results There are59postoperative pancreatic fistula cases, in which1case died of intraperitoneal hemorrhage and others recovered after proper therapies. Keeping abdominal drainage unobstructed, fasting, gastrointestinal decompression, inhibiting pancreatic enzyme secretion, using the antibiotics reasonably, nutrition, fluid replacement and other supportive treatments were primary treatments for the recoveries.6cases were punctured and placed a tube guided by B ultrasound, and7cases were treated with reoperation. We found that VFA, hyperlipidaemia, operation time, pancreas capsule stripping, pancreas injury, lymph nodes dissection around pancreas, radical gastrectomy with spleen dissection, radical gastrectomy with spleen and partial pancreas dissection and tumor pathological classification(pTNM) were risk factors of postoperative pancreatic fistula. The amylase value of drainage fluid on the first postoperative day was effective to forecast postoperative pancreatic fistula.Conclusion Large VFA, hyperlipidaemia, cancer invasion of the pancreas, long operating time and all the operative procedures that could injure pancreas or pancreiatic duct can increase the risk of postoperative pancreatic fistula. Monitoring the amylase value of drainage fluid is effective for forecast and diagnosis of postoperative pancreatic fistula. Keeping abdominal drainage unobstructed, fasting, gastrointestinal decompression, inhibiting pancreatic enzyme secretion(using Octreotide and so on), using the antibiotics reasonably, nutrition, fluid replacement and other supportive treatments are effective treatment measures.