The Analysis Of Risk Factors About Complications After Pancreatoduodenectomy

Objective:To summarize the prevention and treatment experience of complications,and provide reference for clinicians through studying the risk factors of complications after pancreaticoduodenectomy,.The final goal is reducing incidence of postoperative complications and early mortality.Methods:The clinical datas of 355 patients in the second affiliated hospital of kunming medical university from January 2010 to December 2017 were retrospectively analyzed.All patients with pancreaticoduodenectomy,sex,age,Body Mass Index(Body Mass Index BMI),preoperative whether diabetes mellitus,whether preoperative hypertension,history of upper abdominal surgery,preoperative hemoglobin(HGB),preoperative albumin(ALB),preoperative Total Bilirubin(TBIL),preoperative alanine aminotransfease(ALT),operation time,intraoperative blood loss and bile duct diameter,the diameter of the pancreatic duct,pancreatic texture,and whether to clear lymph nodes as observations factors to postoperative pancreatic fistula(POPF),bile leakage,postpancreatectomy hemorrhage(PPH),gastrointestinal anastomotic fistula,abdominal infection,pulmonary infection and delayed gastric emptying(DGE)as the dependent variable were taken.The clinical data were analyzed by using univariate analysis and then two categories of non-conditional stepwise logistic regression model was used for multivariate analysis.Results:All 355 cases of pancreaticoduodenectomy were analyzed in this study,there were 88 patients with the above complications(24.79%).The distribution of pancreatic fistula in 39 cases(10.99%),bile leakage in 11 cases(3.10%),postpancreatectomy hemorrhage in 43 patients(12.11%),gastrointestinal anastomotic fistula in 7 cases(1.97%),abdominal infection in 57 cases(16.06%),pulmonary infection in 31 cases(8.73%),and 4 cases in gastric emptying disorder(1.13%),respectively.Early postoperative complications died 24 cases and the mortality was 6.76%.The main causes of early postoperative death were analyzed,of these,14 died from pancreatic fistula,6 died from postpancreatectomy hemorrhage,2 died from abdominal infection,2 died from pulmonary infection,and pancreatic fistula and postpancreatectomy hemorrhage were the main causes of early postoperative death.Univariate and logistic multivariate analysis were used,age(?60 years),preoperative hypertension,diabetes mellitus,TBIL(?170 umol/L),operation time(?10h)were the influences of postoperative pancreaticoduodenectomy total risk factors of complications(P<0.05).The risk factors for pancreatic fistula were age(?60 years),hypertension,diabetes mellitus,BMI(?25 kg/m2)and operation time(>10 h)(P<0.05).The BMI(?25Kg/m2)and diabetes mellitus were risk factors of bile leakage.The BMI(?25Kg/m2),diabetes mellitus and pancreatic fistula were risk factors ofpostpancreatectomy hemorrhage.Unobserved factors were the risk factors for gastrointestinal anastomotic fistula(P>0.05).The risk factors for pulmonary infection were age(?60 years)?BMI(?25Kg/m2)(P<0.05).Unobserved factors were the riskfactors for gastrointestinal anastomotic fistula(P>0.05).The risk factors for abdominal infection were age(?60 years),BMI(?25Kg/m2),TBIL(?170 umo/m2)and ALB(<35g/L)(P<0.05).Unobserved factors were the risk factors for gastric emptying(P>0.05).According to the standard ofa=0.05,multivariate Logistic regression analysis was performed for variables with statistically significant differences in single factor analysis.The results showed that age(?60 years),history of diabetes and TBIL(?170 umol/L)were independent risk factors for total complications after pancreaticoduodenectomy(P<0.05).BMI(?25 Kg/m2)was the independent risk factor for pancreatic fistula(P<0.05).BMI(?25 Kg/m2)was the independent risk factor for bile leakage(P<0.05).Pancreatic fistula was the independent risk factor for postpancreatectomy hemorrhage and abdominal infection(P<0.05).BMI(?25 Kg/m2)was the independent risk factor for pulmonary infection(P<0.05).Conclusion:1.There are many complications after pancreatoduodenectomy,the incidence of complications and early mortality were high.The pancreatic fistula and hemorrhage were the leading cause of death after pancreaticoduodenecomy.2.Age,BMI,preoperative hypertension,preoperative diabetes mellitus,TBIL and ALB were the major risk factors for postoperative complications of pancreaticoduodenectomy.3.Prevention and treatment of hazards can reduce the complications after pancreaticoduodenectomy.