| ObjectiveTo investigate the effect of pancreaticojejunostomy on the occurrence of post-operative pancreatic fistula(POPF) after pancreaticoduodenectomy, and to verify whether the occurrence of postoperative pancreatic fistula is reduced with improved pancreaticojejunostomy. To validate the effects of four styles of pancreaticojejunostomy following pancreaticoduodenectomy on postoperative complications.MethodsData from 145 consecutive patients with periampullary tumor who underwent pancreaticoduodenectomy in Tianjin Medical University Cancer Institute and Hospital between October 2008 and August 2013 were reviewed. Preoperative general information, including of pancreatic hardness(1, 2, 3, soft, medium and hardness), age greater than 70 or less than 70 years old, gender, preoperative biliary infection or not,, main pancreatic duct diameter >3mm, common bile duct diameter >10mm. Intraoperative factors include pancreatic duct stent placement,external drainage of pancreatic juice, T tube placement, intraoperative blood transfusion, intraoperative blood loss(greater than 400 ml or not). According to the different anastomosis methods, patients were divided into four groups: end-to-end anastomosis in 50 cases, end to side anastomosis in 18 cases, pancreatic duct to jejunum mucosa in 34 cases, Blumgart anastomosis in 43 cases. Four kinds of anastomosis methods, together with preoperative and intraoperative factors were analyzed for the risk of POPF by using univariate analysis. Factors potentially associated with POPF were analyzed by Pearson ? 2test and Logistic regression analysis. Finally, postoperative complications were compared among four types of pancreatic enteric anastomosis to find the relationship between postoperative complications and pancreaticojejunostomy types.ResultsOf the 145 patients,27 patients were diagnosed with POPF,including 5 in grade A,17 in grade B and 5 in grade C. Neither duct to mucosa( DTM) nor Blumgartpancreaticojejunostomy was correlated with POPF in grade C. Univariate analysis showed that gender(P=0.020), pancreatic cancer(P=0.007), portal vein involvement(P=0.008), type of pancreaticojejunostomy(P=0.004), texture of pancreas(P=0.000)and diameter of main pancreatic duct(MPD)(P=0.001) were closely correlated with POPF. Age >70(P=0.633), common bile duct diameter>10mm(P=0.292),preoperative biliary infection(P=0.830), pancreatic duct stent(P=0.652), external drainage(P=0.955), T tube drainage(P=0.928), intraoperative blood loss(P=0.400),and intraoperative blood transfusion(P=0.701) were not statistically different for the occurrence of POPF. Multivariate analysis using Logistic regression showed that different pancreaticojejunal anastomosis(P=0.003), gender(P=0.040)and portal vein invasion(P=0.002) were independent predictors of POPF. Comparison between four types of pancreaticojejunostomy and postoperative complications, postoperative pancreatic fistula only showed statistical difference(P=0.004). Different pancreaticojejunostomy can influence the postoperative pancreatic fistula rate.Postoperative biliary fistula(P=0.215), gastrointestinal bleeding(P=0.087), biliary tract bleeding(P=0.776), abdominal cavity hemorrhage(P=0.369), abdominal infection(P=0.429) and pulmonary infection(P=0.556) were not statistically different among four types of pancreaticojejunostomy.ConclusionDifferent types of pancreatic anastomoses is a risk factor of POPF after pancreaticoduodenectomy. The risk factors of pancreatic fistula include sex,pancreatic carcinoma, portal vein involvement, type of pancreaticojejunostomy, main pancreatic duct diameter and pancreatic hardness. Only the pancreaticojejunostomy belongs to artificial controllable factors, Therefore, focusing on the improvement of pancreaticojejunostomy method will be feasible to lower the incidence of POPF.Blumgart anastomosis can significantly reduce the incidence of POPF. Being simple and easy to operate, together with its reliability, Blumgart anastomosis can be widely used in clinic. |
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