The Influence Of Pancreatic Leakage After Pancreaticoduodenectomy With Different Ways Of Pancreaticojejunostomy

Aims:Through analyzing the occurrence of pancreatic leakage after pancreaticoduodenectomy (PD) in different ways of pancreaticjejunum anastomosis,we explore the importance of precaution to pancreatic leakage after pancreaticoduodenectomy (PD) with a reasonable way to pancreatic anastomosis.Methods:The clinical data was retrospectively analyzed which undergoing PD in the Department of General Surgery, the First Hospital of Lanzhou University from January 2009 to January 2014. According to the different pancreaticojejunostomy ways, the 115 cases were dividedinto three groups:the invagination pancreaticojejunostomy group(45 cases,group A), the duct-to-mucosa anastomosis group (54 cases, group B), the pancreatic duct-jejunum mucosal anastomosis group (16 cases, group C). The incidence of pancreatic leakage was compared after pancreaticoduodenectomy in these three groups. The statistical software SPSS 21 was used to analyze the potential perioperative elements for the pancreatic leakage after pancreaticoduodenectomy with univariate regression model.Results:Twenty cases occured leakage after operation in the total 115 cases, with the occurrence of 17.4%(20/115) including 10 cases (22.2%),4 cases(7.4%) and 6 cases(37.5%) respectively in the group A, group B and group C. The incidence of pancreatic leakage in these three groups is not same (x2=8.891,P=0.011). The occurrence of pancreatic leakage between invagination Pancreaticojejunostomy and duct-to-mucosa anastomosis is significant different (P= 0.049,95% CI= 0.00～0.30). The occurrence of pancreatic leakage between duct-to-mucosa anastomosis and duct-to-seromuscular layer anastomosis is also significant different (P= 0.005, 95% CI= 0.51～0.09). The occurrence of pancreatic leakage between invagination Pancreaticojejunostomy and duct-to-seromuscular layer anastomosis is not statistically significant difference (P= 0.157,95%CI= 0.37～0.06). The univariate analysis indicated that sex, age, smoking history, the level of preoperative albumin, the degree of preoperative jaundice, presence of diabetes, pancreatic tube diameter, the pancreas texture, sickness types are no closing to postoperative pancreatic leakage. Pancreaticojejunostomy was the independent hazard element to pancreatic leakage after PD.Conclusions:High quality anastomosis technique is an important guarantee to avoid pancreatic leakage after PD. The technique of duct-to-mucosa anastomosis is more easier to master than other ways which with low incidence of pancreatic leakage.