Clinical Analysis Of 129 Cases Operated Of Pancreaticoduodenectomy

Objective:Through after pancreaticoduodenectomy patients’ records were retrospectively studied discuss the risk factors of early major complications and death after pancreaticoduodenectomy, in order to help to reduce the incidence of complications,mortality rate and clinical work.Methods:Retrospective analyze the clinical data of 129 routine pancreaticoduodenectomy(PD)patients who were included according to the exclusion criteria for the study between June2009 and June 2014 of the Second Hospital of Shanxi Medical University, Cancer Hospital.There are 49 female(38.0%), male 80 cases(62.0%) in the 129 patients, aged from 22 to79 years old, the mean age is 56.1 years old. Put the gender, age(= 65 years old), whether combined with other complications before surgery(mainly refers to high blood pressure,diabetes, heart disease), preoperative albumin level(= 35 g / L), the total bilirubin and albumin level of serum(= 171 umol / L), the duration of preoperative jaundice(= 30 days),operative time(= 6h), intraoperative blood loss(= 1000ml), pancreas texture,pancreaticojejunostomy way, whether indwelling duct support tube, the main pancreatic tube diameter(= 3mm), tumor location, tumor size, nature 15 indicators as a research object, the form may affect the design of early postoperative complications(pancreatic fistula, biliary fistula, bleeding, infections(including intra-abdominal infections, lung infections), delayed gastric emptying, multiple organ dysfunction syndrome, wound infection) were both risk factors for classification of single factor analysis, and thenproceed to each single factor Logistic regression analysis(P <0.05). Evaluate the incidence of early postoperative complications in PD and its associated risk factors.Results:In the 129 cases of PD patients in this group, there were 58 cases(45.0%) of major complications after one month of surgery, in which 32 cases of pancreatic fistula(24.8%),31 cases of infection(24.0%), 13 cases of bleeding(10.1%), biliary fistula 12 cases(9.3%),wound infection in 11 cases(8.5%), gastric emptying dysfunction in 10 cases(7.8%),MODS3 patients(2.3%), 6 cases(4.7%) died. Statistical analysis showed that the total bilirubin and albumin level of serum, intraoperative blood loss and nature of the tumor were related with the early postoperative complications after the univariate analysis.(P<0.05, and OR> 1).The above 15 independent risk factors performed by logistic Forward of multivariate analysis method show: intraoperative blood loss, the diameter of the main pancreatic duct and pancreatic tumor properties were the independent risk factors which affecting postoperative complication rate of the early days; The intraoperative blood loss was the independent risk factor of the occurrence of biliary fistula and the bleeding; the duration of preoperative jaundice, intraoperative blood loss and the diameter of the main pancreatic duct were the independent risk factors of the occurrence of pancreatic fistula;the total bilirubin and albumin level of serum was the independent risk factor of infection’s occurrence(all P <0.05).Conclusions:Pancreaticoduodenectomy is still a high-risk surgery, the incidence of early postoperative complications was still high, but the mortality has decreased, Main causes of death were multiple organ dysfunction syndromes which were evoked by various complications and abdominal infections, bleeding. The incidence of postoperative complications and mortality were higher when the patients’ intraoperative blood loss achieved 1000 ml, or the diameter of the main pancreatic duct was less than 3mm, or theproperties of tumor were malignant. The patients’ intraoperative blood loss achieved1000 ml could Increase the risk of biliary fistula and bleeding occurred after PD. the duration of preoperative jaundice, intraoperative blood loss and the diameter of the main pancreatic duct were the independent risk factors of the occurrence of pancreatic fistula.The total bilirubin and albumin level of serum impacted on the incidence of postoperative infectious complications of PD. Age did not influence the incidence of various complications after PD.