| Objective: To investigate the effect of bundled ligation of the pancreatic stump on the occurrence of postoperative pancreatic fistula(POPF)after distal pancreatectomy(DP),and to evaluate its safety and efficacy.Methods: The clinical data of 112 patients who underwent DP from January 2012 to January 2017 were analyzed retrospectively from the hepatobiliary pancreatic center of Sichuan Provincial People's Hospital.According to the pancreatic stump in DP was whether or not being bundled,these patients were divided into two groups,which were the group of bundled ligation of the pancreatic stump(bundled group)with 53 patients and the group of non bundled ligation of the pancreatic stump(non bundled group)with 59 patients.The above two groups were further divided into two subgroups respectively according to the different ways of pancreatic stump closure,which were manual suture group and staple closure group.In the bundled subgroup,there were 39 patients in the manual suture group and 14 patients in the staple closure group;While in the non bundled group,the number was 40 patients and 19 patients respectively.Then the preoperative general data(gender,age,body mass index,hemoglobin,albumin,total bilirubin,combined diseases,history of abdominal surgery),intraoperative general data and Pathological data(the closure of pancreatic stump,operation time,intraoperative blood loss,intraoperative blood transfusion,cases of splenectomy,cases of combined vascular resection,cases of combined with other organs resection,pancreatic texture,pathological diagnosis),postoperative recovery and follow-up data(the volume of abdominal drainage tube,cases of postoperative blood transfusion,the time of indwelling drainage tube,postoperative hospital stay,hospital costs,cases of reoperation,cases of readmission in one month after discharge)of all patients were analyzed,as well as the incidence of postoperative complications,especially the incidence of complications such as POPF.Results: 1.There was no significant difference between the bundled group and the none bundled group in the preoperative general data(gender,age,body mass index,hemoglobin,albumin,total bilirubin,combined diseases,history of abdominal surgery)(P>0.05).2.In the bundled subgroup,there was also no significant difference between the manual suture group and the staple closure group in the preoperative general data(gender,age,body mass index,hemoglobin,albumin,total bilirubin,combined diseases,history of abdominal surgery),as well as the none bundled subgroup(P>0.05).3.There was no significant difference between the bundled group and the none bundled group in the intraoperative general data and Pathological data(the closure of pancreatic stump,operation time,intraoperative blood loss,intraoperative blood transfusion,the cases of splenectomy,the cases of combined vascular resection,the cases of combined with other organs resection,pancreatic texture,pathological diagnosis)(P>0.05).4.There was no perioperative death in the 2 groups,but a total of 35 patients suffered from postoperative complications,with a rate of 31.3%(35/112).In the two groups,12 patients suffered from complications in the bundled group,with a rate of 22.6%(12/53);and 23 patients suffered from complications in the non bundled group,with a rate of 39.0%(23/59).The incidence of complications was lower in the bundled group than that in the non bundled group,but showing no significant difference between the 2 groups(P>0.05).(1)In terms of POPF(grade B + grand C)in the two groups,there were 2 patients with POPF in the bundled group and 10 patients with POPF in the non bundled group,the incidence was 3.8%(2/53)and 17.0%(10/59),respectively,showing a significant difference between the 2 groups(P<0.05).(2)In the grading of POPF,there were 2 patients with grade B in the bundled group and 9patients with grade B in the non bundled group,the incidence was 3.8%(2/53)and 15.3%(9/59),respectively,showing a significant difference between the 2 groups(P<0.05).However,there was no significant difference between the 2 groups in grade C and biochemical leak(grade A)(P>0.05).(3)In the bundled subgroup and the none bundled subgroup,the incidence of POPF was2.6%(1/39)and 15.0%(6/40)in the manual suture group,respectively;the incidence of POPF was 7.1%(1/14)and21.1%(4/19)in the staple closure group,respectively.In the two subgroups,the incidence of POPF in the staple closure group was all significantly higher than that in the manual suture group(7.1% VS 2.6%,21.1% VS 15.0%),but showing no significant difference(P>0.05).In the grading of POPF,there was also no significant difference between the staple closure group and the manual suture group in the above 2 subgroups(P>0.05).(4)There was no significant difference between the bundled group and the none bundled group in the incidence of postoperative hemorrhage(1.9% VS 0%),delayed gastric emptying(1.9% VS 0%),peritoneal effusion(13.2% VS 20.3%),abdominal infection(1.9%VS 8.5%),intestinal obstruction(5.7% VS 1.7%),wound infection(3.8% VS 6.8%)and other complications(P>0.05).5.In the aspect of the postoperative recovery and the follow-up data.There was no significant difference between the 2 groups for the volume of abdominal drainage tube in the first 3 days(P>0.05),but the volume was significantly lower in the bundled group than that of the non binding group on the fourth day and the fifth day,showing a significant difference(P<0.05).In addition,the bundled group in the time of indwelling abdominal drainage tube(8d VS 12d),postoperative hospital stay(9d VS 13d),hospital costs(46165.85±11120.29 yuan VS 51751.14±15675.09yuan)is better than that of the non bundled group,showing a significant difference(P<0.05).However,in the aspect of the cases of postoperative blood transfusion,the cases of reoperation,the cases of readmission in one month after discharge,there was no significant difference between the 2groups(P>0.05).Conclusion: 1.The bundled ligation of the pancreatic stump could effectively reduce the incidence of POPF after DP,especially for the prevention of grade B POPF.2.At the same time of strengthening the sealing effect of the pancreatic stump to reduce the incidence of POPF,the bundled ligation not only could effectively reduce the volume of abdominal drainage tube,the time of indwelling abdominal drainage tube,postoperative hospital stay,and promote patients recovery,but also could reduce the hospital costs and lessen the financial burden of patients.3.The bundled ligation,which might reduce the damage of pancreatic tissue just by effectively reducing the density of pancreatic stump suture and the uncertainty factor of the staple closure,could be a simple,safe and effective method. |
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