Analysis Of The Cause For Perioperative Death After Resection Pancreas Duodenum

Purpose:To analyze the related factors of death after standard of Pancreaticoduode-nectomy(SPD)and provide the reference for the improvement of the operation safety.Methods:the hospitalize patients in 163 cases with PD surgery in the hepatobiliary and pancreatic department of affiliated Hospital of Yanbian University from September 2008 to September 2016 were collected and followed by 3-6 months,the relevant risk factors of postoperative death of PD were analyzed and studied.Results:(1)there were no significant difference in sexes and history mortalities.there was significant difference between the groups above 65(including 65)and below 65:the postopartive motality of the group above 65(including 65)was 14.58%,the postopartive motality of the group below 65 was 2.86%.(2)the complications of post PD included:pancreatic fistula,biliary fistula,abdominal infection,postoperative bleeding and so on.The incidence of pancreatic fistula was 8.00%,the incidence of biliary fistula was 3.70%,the incidence of abdominal infection was 4.90%,and the incidence of postoperative hemorrhage was 3.70%.The incidence of pancreatic fistula,biliary fistula,abdominal infection and postoperative hemorrhage was correlated with postoperative mortality.The mortality of the group with pancreatic fistula was a 38.50%,no pancreatic fistula group was 3.30%,the mortality of the group with postoperative hemorrhage was 75.00%,no postoperative hemorrhage group was 2.60%,the mortality of the group with biliary fistula was 50.00%,no biliary fistula group was 4.50%,the mortality of the group with abdominal infection was of 50.00%,no abdominal infection group was 3.90%,the difference was statistically significant;(3)No statistically significant difference in postoperative mortality of common bile duct tumors,pancreatic head tumors,duodenal tumors and tumor size;(4)There was no statistically significant difference in mortality among the groups with different preoperative TBIL levels and albumin levels;preoperative hemoglobin level were related with postoperative mortality,the motality of the group with preoperative Hb<90g/L PD was 33.33%,the motality of the group with preoperative Hb?90g/L was 4.50%,and the difference was statistically significant.(5)There was no statistically significant difference in postoperative mortality between the groups with operation time<5h and operative time?5h;there was no statistically significant difference in postoperative mortality between the groups with blood transfusion<1000ml and the group with blood transfusion? 1000ml;the postoperative mortality of the group with intraoperative bleeding<800ml was 4.10%,the intraoperative hemorrhage? 800ml group was 26.70%,and the difference was statistically significant.(6)The difference of liquid input in Operation Day in the death group was significantly higher than that of the no death group after PD operation,and the difference was statistically significant.Conclusion:? Age(? 65 years),pancreatic fistula,biliary fistula,abdominal infection?postoperative hemorrhage and intraoperative bleeding(?800ml)were the risk factors for postoperative mortality;?Preoperative hemoglobin level(?90g/L)was the protective factor of postoperative death in PD.?Based on the retrospective analysis,the predictive equations of postoperative mortality were established:P=1/e-(-3.423+2.241age+3.643biliary fistula +2.990 abdominal infection-2.818 preoperative hemoglobin level +3.180 intraoperative hemorrhage +2.511 postoperative hemorrhage)?...