Pancreatic Duct Stent Internal Versus External Drainage With Pancreaticojejunostomy For The Curative Effect After Pancreaticoduodenectomy

Objective：Pancreaticoduodenectomy,which is also known as Whipplesurgery, is the main choice of treatment for patients with the cancer of thehead of the pancreas and periampullary adenocarcinoma. Pancreatic fistulaafter PD is a permanent topic of pancreatic surgeon, and it can continulypromote PD improving and developing. Surgeon takes many measures ofanastomosis, technique, sutures, fibrin glue, anastomotic stent and newmedicine to prevent pancreatic fistula. Anastomotic stent have a veryimportant significance to prevent pancreatic fistula after PD. Currently,there is no consensus on the best way of anastomotic stent after PD. Thereare little reports which compared between internal stent and external stent.By analyzing information of patients, we want to compare the outcomes ofinternal and external of stent patients in light of recognized risk-factors forthe development of clinically relevant postoperative pancreatic fistulas andto determine value of preventing pancreatic fistulaMethods：The clinical records of107patients where were in China-JapanUnion Hospital Of JiLin University who underwent standard PD areanalyzed retrospectively. The stent drainage of pancreatic duct is used in84of107patients，including stented internal drainage of pancreatic duct in49（58.3%）patients and stent external drainage of pancreatic duct in35（41.7%） patients, and without stent drainage in18and5pancreatogastrostomy patients are excluded in this research. All patientsunderwent pancreaticoduodenectomy and put an appropriate stent in pancreatic duct. Patients are analyzed of age, sex, time of jaundice,hypertension, heart disease, diabetes, total bilirubin, direct bilirubin,indirect bilirubin, total protein, albumin, hemoglobin, illnesscomposition,anastomosis, pancreatic texture, duct diameter, biliary fistula,gastrointestinal/intestinal anastomotic fistula, gastrointestinal bleeding,pulmonary complications, wound infection, reoperation, somatostatin,postoperative mortality, length of stay and other indicators of differences,related risk factors for pancreatic fistula to find out the relationshipbetween internal and external of stent and pancreatic fistula.Results：Patients of age, sex, time of jaundice, hypertension, heartdisease, diabetes, total bilirubin, direct bilirubin, indirect bilirubin, totalprotein, albumin, hemoglobin, illness composition, pancreatic texture, ductdiameter,biliary fistula,gastrointestinal/intestinal anastomotic fistula,gastrointestinal bleeding, pulmonary complications, wound infection,reoperation, somatostatin, postoperative mortality, length of stay are all nostatistical meaning. There are12case pancreatic fistula of internal stent（24.5%）and2case pancreatic fistula of external sten（t5.7%）,and they arestatistical difference（P=0.023）.Conclusions: Pancreatic ductal stent external drainage can effectivelyreduce the morbidity of pancreatic fistula.