| Purpose: Pancreaticoduodenectomy(pancreaticoduodenectomy PD)is the standard operation type for pancreatic and periampullary tumor,and it is recognized as the largest general surgery type because of its large operation range,complex digestive tract reconstruction process.With the advent of laparoscopic technique and application of laparoscopic pancreaticoduodenectomy(laparoscopic pancreaticoduodenectomy LPD)has been carried out in clinical,but investigators are still very worried of the postoperative complications,the most serious were pancreatic fistula.So the research on the related risk factors of postoperative pancreatic fistula,to reduce the incidence of pancreatic leakage,has become a hot and key research and discussion at home and abroad in the field of laparoscopic pancreatic surgery.Therefore,this study analyzed and explored the risk factors and prognosis of pancreatic fistula after laparoscopic pancreaticoduodenectomy,in order to reduce the incidence of postoperative pancreatic fistula,so that more patients benefit from the surgery.Method: The clinical data of 128 patients undergoing laparoscopic pancreaticoduodenectomy in the Department of hepatobiliary surgery of the Hebei Medical University hospital from November 2013 to september 2016 were analyzed retrospectively.According to the occurrence of pancreatic fistula after operation,the patients were divided into pancreatic fistula group and non pancreatic fistula group,there were 21 males and 15 females in the pancreatic fistula group;the age of the patients ranged from 35~78years old,and the average age is 61.44±8.12.There were 58 males and 34 females in the non pancreatic fistula group,the age of the patients ranged from 27~81years old,and the average age is 59.84±10.07.Pathological types include:36 cases of bile duct adenocarcinoma,1 cases of chronic inflammation of the commonbile duct,17 cases of adenocarcinoma of the ampulla of Vater,27 cases of pancreatic ductal adenocarcinoma,13 cases chronic inflammation of the pancreas,28 cases of duodenal papilla carcinoma,and 6 cases of duodenal papilla adenoma(Table 1).The patients with preoperative total bilirubin >171 umol/L were treated with preoperative endoscopic naso biliary drainage(endoscopic nasobiliary drainage,ENBD)or percutaneous transhepatic biliary drainage(percutaneous transhepatic cholangial drainage,PTCD),when the total bilirubin below 171 umol/L,treat the patients with surgical.Smoking in the past need Pulmonary function tests and forbidden smoking for more than 2weeks.Hypoproteinemia was treated with plasma albumin above 30 g/L;when the patients anemia preoperative,infusion concentration red cell and then check blood routine index,we could give patients surgical treatment when the hemoglobin level up to 70 g/L;cleaning enema 1 D preoperative and indwelling catheter and gastric tube;fasting water in the early postoperativeand and routine use proton pump inhibitors to protect gastric mucosa,at the same time,give the patients anti infection,protect liver,resolve phlegm,correction of hypoproteinemia,nutritional support and symptomatic treatment.After operation,observe the drainage of the drainage tube every day,check the content of amylase in the drainage fluid.Applicate the principle of statistical comparison in two groups of patients with age,gender,preoperative albumin,preoperative total bilirubin;intraoperative observation of operative time,intraoperative blood loss,pancreatojejunostomy;postoperative observation records whether patients had delayed pancreatic fistula,biliary fistula,gastric emptying(DGE),postoperative bleeding,abdominal infection,surgery once more,mortality,postoperative hospitalization time,postoperative time of ICU.Use SPSS 21 statistical software,according to the classification of patient data in the study,using t test or c2 test analysis,further using multivariate Logistic regression model for multivariate analysis of predictive factors,analysis the related factors which may lead the postoperative pancreatic fistula and prognosis.Result: According to the occurrence of pancreatic fistula after surgery,the patients were divided into two groups: pancreatic fistula group and non pancreatic fistula group,36 cases of pancreatic fistula group,and the other group of non pancreatic fistula group is 92.The results were statistically analyzed:1 Before operation,there was no significant difference in age,sex,preoperative albumin,preoperative total bilirubin and non pancreatic fistula group(P>0.05).The body mass index(BMI)was significantly different between the pancreatic fistula group and the non pancreatic fistula group(P<0.05),these results suggest that BMI may be associated with the occurrence of postoperative pancreatic fistula.Using multivariate Logistic regression analysis of all the variables of clinical data,it was found that the difference of BMI(OR=1.895,95%CI:1.067 ~ 3.365,P=0.029)in pancreatic fistula group and non pancreatic fistula group was statistically significant.These results suggest that BMI is an independent risk factor for postoperative pancreatic fistula,and when BMI >25,it was prefer to happen.2 Intraoperative condition:the time of operation in the patients with pancreatic fistula was not statistically significant(P>0.05).While the patient bleeding,pancreatic enteric anastomosis between pancreatic fistula group and non pancreatic fistula group had significant difference(P<0.05),indicating the amount of intraoperative bleeding,pancreatic enteric anastomosis and postoperative pancreatic fistula may be related to pancreatic fistula.Multi factor Logistic regression model analysis the clinical data of all variables,found that the amount of bleeding(OR=1.558,95% CI:0.906-2.679,P=0.109)and anastomotic mode(OR=2.338,95%CI:0.954-5.731,P=0.063)is not independent risk factors of postoperative pancreatic fistula.3 After the operation : there was no significant difference between the patients with pancreatic fistula and non pancreatic fistula in the postoperative biliary fistula,gastric emptying disturbance(DEG)and mortality(P>0.05).The postoperative bleeding,abdominal infection,and the 2 operation rate of pancreatic fistula group were significantly increased(P<0.001),and the postoperative hospitalization time and postoperative ICU time in the nonpancreatic fistula group were shorter(P<0.001),and the difference was statistically significant.Conclusion:1 There was a correlation between BMI,intraoperative blood loss,intestinal anastomosis and postoperative pancreatic fistula.Only BMI was an independent risk factor for pancreatic fistula,and pancreatic fistula occurred when BMI>25.2 There was no correlation between the occurrence of pancreatic fistula after laparoscopic pancreaticoduodenectomy and postoperative mortality,but the occurrence of pancreatic fistula significantly increased postoperative complications,prolonged hospitalization time and postoperative ICU time.3 It is possible to reduce the incidence of postoperative pancreatic fistula in patients with small BMI before surgery,and to reduce the amount of intraoperative blood loss,and to choose the skilled operation of the intestinal anastomosis. |
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