Pancreatic Fistula After Pancreaticoduodenectomy: A Retrnalysisospective A

Pancreaticoduodenectomy (PD) is a complex operation with a large trauma, and itcan lead to lots of postoperative complications and it has a high mortality. The pancreaticfistula is the most common and serious complication after operation. Over the years,scholars have been trying to decrease the incidence of pancreatic fistula, but its incidenceis still high. This article has tried to evaluate the effect of jejunum cavity dra-inage onprevention of pancreatic fistula of the PD postoperative in432cases by a retrospectiveanalysis; and made an analysis of risk factors for pancreatic fistula; The article studied themethod on prevention and treatment of C-level pan-creatic fistula,in order to seek formethod on more reduce the incidence of pancreatic fistula after PD.ObjectiveThe article investigated the effect of jejunum cavity drainage on prevention ofpancreatic fistula, and made an analysis of risk factors for pancreatic fistula and exploredthe prevention and treatment on C-level pancreatic fistula. The research is divided intothree parts:1.To study the effect of jejunum cavity drainage on prevention of pancreaticfistula.2. To analyze the risk factors of postoperative pancreatic fistula.3. To probe the method on prevention and treatment of C-level pancreatic fistula.Method1. To study432cases of PD postoperative by a retrospective analysis. The jejunumcavity drainage was used in265cases，stented internal drainage of pancreatic duct in123cases，and stented external drainage of pancreatic duct in44cases; Make a statisticalanalysis on the clinical efficacy of jejunum cavity drainage on prevention of pancreaticfistula.2. To make a statistically analysis for the risk factors on38cases of pancreatic fistulaof PD postoperative by the methods of univariate and multivariate3. To make a statistically analysis for risk factors on C-level pancreatic fistula of PDpostoperative via compared with A/B pancreatic fistula; To evaluate the accuracy ofpredictive for pancreatic fistulaResults1. The incidence of postoperative pancreatic leakage: low incidence of pancreaticleakage in jejunum cavity drainage group (6.0％) that it had significant differencecompared with the internal drainage group(13.8%)（P <0.05), however, the pancreaticleakage incidence of jejunum cavity drainage group (6.0％) had no significant differencecompared with the external drainage group(11.4％)（P>0.05）, To compare the dailydrainage volume of digestive juice after operation, we found that there is a statisticalsignificance on drainage volume starting from the sixth day of postoperation. We alsofound that there is significant difference on drainage volume starting between the first andsecond five days after operation.2.Univariate analysis of risk factors of pancreatic fistula: pancreatic duckdiameter<3mm、Serum albumin<30g/L、benign、soft pancreas and Intraoperativebleeding loss≥1000ml, which are the risk factors for pancreatic fistula；The result ofMultivariate analysis: pancreatic duck diameter<3mm、benign、soft pancreas, which is theIndependent risk factors for pancreatic fistula。3.Multivariate analysis of risk factors of pancreatic fistula: peroperative transfusion and postoperative bleeding are the risk factors of C-level pancreaticfistula. The sensitivity(40%)、specificity(97%) and accuracy(89.5%) of postoperativebleeding is used to evaluate the C-level for pancreatic fistula.Conclusion1. Jejunum cavity drainage can reduce the upper jejunum fluid retention in the earlystage after PD, it has certain effect for the prevention of pancreatic leakage; Comparedwith the stented external drainage group，patients in the jejunum cavity drainage group canreduce the loss of digestive juice effectively after their gastrointestinal function recovered.2. Pancreatic duck diameter<3mm、benign、soft pancreas is the Independent riskfactors for pancreatic fistula.3. Transfusion, postoperative bleeding is the risk factors of C-levelpancreatic fistula, it could contribute to prognosis C-level pancreatic fistula. It needsuniform standards for the diagnosis and treatment of C-level pancreatic fistula.