Multivariate Analysis Of Risk Factors Of Pancreatic Fistula After Pancreaticoduodenectomy

Objectives:Pancreaticoduodenectomy is the main treatment for pancreatic carcinoma and periampullary carcinoma. The surgery is so difficult and complications are so many, the pancreaticoduodenectomy (PD) has been the difficulty of General Surgery. The clinical case after Pancreaticoduodenectomy from October2009to October2013were retrospective analyzed, to investigate the risk factors of pancreatic fistula after pancreaticoduodenectomy(PD). And the experiences of diagnosis and prevention will be summarized.Methods:Two hundred and three patients who underwent pancreaticoduodenectomy in our center from October2009to October2013were reviewed retrospectively, according to the patients with pancreatic fistula or not, the pancreatic fistula group and Control group can be divided. Analysis of pre-operative and intra-operative risk factors for pancreatic fistula, twelve clinicopathologic factors that could possibly influence pancreatic fistula after pancreaticoduodenectomy were selected for univariate analysis, from that we can find the risk factors that lead to pancreatic fistula (PF) after pancreaticoduodenectomy.Results:Two hundred and three patients who underwent PD in our center are collected, of which126males and77females, aged37to84years old.71cases of lower common bile duct cancer(35.0%),60cases of pancreatic cancer(29.6%),39cases of periampullary carcinoma(19.2%),30cases of duodenal cancer(14.8%),3cases of pancreatic head benign (1.5%).The operations were carried out smoothly, The postoperative complication rate was27.6%(56/203),and pancreatic fistula occurred in20patients(9.9%),35.7%of total complications; bile fistula in7cases, the rate was3.4%;intra-abdominal infections in25cases, the rate was12.3%;6cases of abdominal hemorrhage, the rate was3.0%;5cases of gastrointestinal bleeding, the rate was2.5%;25cases of chest infection, the rate was12.3%;4cases of stress ulcer, the rate was2.0%;delayed gastric emptying in3cases, the rate was1.5%;the remaining minor complications in9cases. Anastomotic techniques, gender, age, diabetes or not operative time, blood loss, intraoperative blood transfusion, pathological diagnosis have nothing to pancreatic fistula(P>0.05). Elevated preoperative serum TBIL level group were significantly higher incidence of pancreatic fistula, low serum albumin levels in patients before surgery increased incidence of postoperative pancreatic fistula, low serum albumin levels after surgery patients increased incidence of pancreatic fistula, postoperative pancreatic fistula pancreatic texture of the high incidence of soft tissue in the pancreas hard texture group, pancreatic duct diameter larger group of patients the incidence of postoperative pancreatic fistula was significantly lower than the duct diameter than the team. Thus the risk factors associated with postoperative pancreatic fistula are preoperative serum TBIL level, preoperative serum albumin levels and postoperative serum albumin levels, the pancreas texture and pancreatic duct diameter.Conclusions:The pathogenesis of pancreatic fistula is complicated, in our center, the analysis show that the independent risk factors are pre-operative TBIL, pre-operative albumin, texture of the pancreas and pancreatic duct diameter. Higher incidence of pancreatic fistula after pancreaticoduodenectomy, monitoring peritoneal drainage fluid amylase levels may contribute to the diagnosis of pancreatic fistula. Pancreatic fistula is the most common complication, it is also an important factor to affect the post-operative long-term survival. Thus during pre-operation intra-operation post-operation, the risk factor should be pay attention to prevent the pancreatic fistula happening.