Meta-analysis Of Risk Factors In Pancreatic Fistula After Pancreatoduodenectomy In China

Objective To explore the risk factors of domestic pancreatic fistula afterpancreatoduodenectomy(PD), and provide a theoretical basis to reduce the incidenceof postoperative pancreatic fistula.Method Meta-analysis was used in33articles on risk factors of the domesticpancreatic fistula after pancreaticoduodenectomy published in China from June2002to June2012.Results Between the group of patients older than65years with the group less than65years the incidence of pancreatic fistula was no significant difference, CombinedOR=0.79(95%Cl:0.47-1.33,P>0.05).The incidence of pancreatic fistula after PD wasno significant difference in male and female patients, combinedOR=1.13(95%Cl:0.85-1.49,P>0.05). The rate of pancreatic fistula after PD hadnothing to do with diabetes, hypertension, coronary heart disease, preoperativealbumin, preoperative hemoglobin(P>0.05). Between pancreatic leakage and healinggroup the time of operation had no significant difference (P>0.05).In the group ofpatient whose level of preoperative jaundice higher than171umol/L the incidence ofpancreatic fistula after PD was significantly higher(combinedOR=1.92,95%Cl:1.32-2.76,P<0.05). The rate of pancreatic fistula after PD was notclearly dropped after preoperative biliary drainage(P>0.05). The bindingpancreaticojejunostomy can effectively reduce the incidence of postoperativepancreatic fistula than the traditional set-in pancreaticojejunostomy(P<0.05). Theincidence of pancreatic fistula between the traditional set-in pancreaticojejunostomyand the pancreaticojejunostomy was no significant difference(CombinedOR=2.32,95%CI：1.34-4.02,P<0.05).The rate of pancreatic fistula of pancreatic ductdiameter greater than3mm has lower than the control group(P<0.05). The incidenceof pancreatic fistula after operation has statistical differences in placed pancreatic ductsupport drainage group and the control group (P<0.05). The rate of pancreatic fistula of pancreatic duct diameter greater than3mm has lower than the control group(P<0.05). In the group of patient,whose the amount of bleeding were more than1000ml,the incidence of pancreatic fistula after PD was significantly higher(P<0.05).The incidence of pancreatic fistula was9.05%（57/630）in the group which was usedsomatostatin postoperative, and the rate was13.81%（88/637）in the group notused(P<0.05). Pancreatic texture (pliable) and operation on abdominal region haddirect relationship with the pathogenesis of pancreatic fistula(P<0.05).Conclusion The rate of pancreatic fistula after PD had no relationship withgender,age,diabetes,hypertension,coronary heart disease, preoperativealbumin,preoperative hemoglobin,operating time and preoperative biliary drainage.Preoperative severe jaundice, small pancreatic duct diameter, without the support ofthe pancreatic duct drainage, the amount of bleeding, pliable pancreatictexture,unused somatostatin and operation on abdominal region are the risk factors ofthe pathogenesis of pancreatic fistula. The traditional sets of binding agreement-incould effectively reduce the incidence of postoperative pancreatic fistula.The bindingpancreaticojejunostomy can effectively reduce the incidence of postoperativepancreatic fistula.