Analysis Of Risk Factors For Pancreatic Fistula After Pancreaticoduodenectomy

Objective:To explore the main risk factors for pancreatic fistula (PF) after pancreaticoduodenectomy (PD).Methods:The clinical data of 98 patients undergoing PD by the same surgeon from December 2014 to December 2015 from the department of the Hepatobiliary and Pancreatic surgery in the First Affiliated Hospital of Zhejiang University were collected. retrospectively. And all the potential perioperative factors for PF were analyzed with univariate and logistic regression multivariate model. Firstly, the univariate analysis of 22 clinical parameters was made. The Independent-Sample t Test was used for normally distributed continuous variables and the non-parametric test (NPar) was used for not normally distributed continuous variables. And the Chi-square test was used for binomial variables. Then the multivariate logistic regression analysis was made for these statistically significant variables. SPSS20.0 software was adopted for statistical analysis to calculate the odd ratio of various variables:OR= Exp (B). The inspection standards a=0.05 and P<0.05 means that the difference was statistically significant.Results:Of all the 98 patients,31 patients (31.6%) occurred PF after PD, including A grade PF14 patients (14.3%), B grade PF14 patients (14.3%), C grade PF3 patients (3.1%).3 patients died during postoperative hospital stay in all the 98 patients with overall mortality of 3.1%(3/98). Among them,2 patients suffered from abdominal bleeding because of severe PF and then died after reoperation and multiple organ failure. Another 1 patient suffered from abdominal bleeding without PF and then died after reoperation and multiple organ failure. Thus, the mortality of PF group was 6.5%(2/31), the mortality of non-PF group was 1.5%(1/67).The mortality of PF group is as 2.1 times as the total mortality and 4.3 times as non-PF group. In univariate analysis, Body Mass Index (BMI), tumor location, tumor diameter and pancreas duct diameter<3mm (≥3mm as dilated pancreatic duct) were associated with PF after PD.T hese 4 statistically significant variables were input SPSS20.0 with the PF as the dependent variable (0=no,l=yes), and multivariate logistic regression analysis revealed that the pancreatic duct diameter<3mm (OR=3.600, P=0.011) and BMI>20.4kg/m2 (OR=2.881,P=0.026) were independent risk factors for postoperative PF after PD.Conclusion:The pancreatic duct diameter<3mm (OR=3.600, P=0.011) and BMI≥20.4kg/m2 (OR=2.881, P=0.026) were independent risk factors for postoperative PF after PD.