Analysis Of Pancreatic Leaking-related Risk Factors After Pancreaticoduodenectomy

Objective:To study the risk factors of pancreatic fistula after pancreatoduodenectomy;To provide scientific basis for perioperative management,intraoperative operation and postoperative management of patients with pancreaticoduodenectomy;To improve the survival rate of patients after pancreaticoduodenectomy and reduce the incidence of postoperative pancreatic fistula complications.Methods:FromApril2012toSeptember2017,therewere113casesof pancreaticoduodenectomy in the major hospital of Shanxi Province,including 68 males and 45 females,with an average age of 51.2 years.Research indicators include:patient's age,gender,whether preoperative diabetes mellitus,if I ever had a history of biliary and pancreatic diseases,BMI(namely the body mass index(BMI),more than 24 defined as overweight,so this study divided the patients into 24 Kg/m~2or,and<24 Kg/m~2),total bilirubin(preoperative use preoperative 1-3 days of venous blood,according to the degree of jaundice 34.2-170 mu for mild jaundice between mol/L;170-340 mmol/L for moderate jaundice;Is more than 340 mu mol/L for severe jaundice,divided the patients into<34.2?mol/L,34.2 170?mol/L,170-170?mol/L and?340?mol/L),preoperative hemoglobin(venous blood of the preoperative 1-3 days)and see the quality of a material of residual pancreatic(according to the performer of judgment),operation duration,postoperative patients with serum albumin(venous blood by postoperative 1-3 days,according to the reported human serum albumin after less than 28 g/L,it will cause the edema disease,so patients can be divided into?28 g/L and<28 g/L).Results:There were 113 patients receiving PD,33 cases of pancreatic fistula(29.2%),including 13 cases(11.5%)of pancreatic fistula,12 cases(10.6%),and 8 cases(7.08%)of pancreatic fistula.Occur,36 cases of upper gastrointestinal bleeding,3 cases of biliary fistula,infectious complications(including incision and lung infection)in 29 cases,appear more than two kinds of complications for 21 cases at the same time,a total of postoperative complications were there for 58 cases(51.3%).PD postoperative various risk factors analysis,according to now the rise of rapid rehabilitation theory,under the various conditions together with the pursuit of the patient's quick recovery,some patients it appears mild postoperative pancreatic fistula,but its rapid recovery,for clinical follow-up treatment effect is not very large,in the school time,so the author focuses on B and C level risk factor for pancreatic fistula.According to the presence of B,C grade pancreatic fistula patients divided into B,C grade pancreatic fistula group and grade B,C,pancreatic fistula,appeal for each risk factor analysis,think always patients biliary pancreatic disease history,BMI,preoperative and postoperative serum albumin and total bilirubin discretion postoperative PF related,such as age,gender,or other diabetes,duration of surgery,and the remnants of the pancreas texture,etc.No significant correlation with the incidence of postoperative PF.The premise and the single factor analysis of the results of four related risk factors,Logistic multi-factor analysis,the results showed that the BMI of preoperative patients with total bilirubin,and postoperative serum albumin is associated with the occurrence of postoperative pancreatic fistula with statistical significance.Conclusions:Determination of preoperative patients with elevated bilirubin,BMI greater than 24kg/m~2,postoperative serum albumin values less than 28 g/L is PD postoperative B and C level independent risk factor for pancreatic fistula occurred,therefore in the preoperative jaundice,obese patients should pay attention to the management of preoperative and intraoperative careful operation,postoperative hypoalbuminemia patients to strengthen nutrition,albumin supplementation,as far as possible to reduce the occurrence of severe postoperative pancreatic fistula,for the patient's psychological,physiological and quick rehabilitation has the positive significance.