Analysis Of Risk Factors Of Complications And Survival After Pancreaticoduodenectomy In 203 Patients

ObjectiveTo explore the prevention and reduction of postoperative complications,common complications and the measures to improve the survival time by analyzing the complications after pancreatoduodenectomy and the influencing factors of long-term survival.Materials and methodsA total of 203 patients underwent pancreatoduodenectomy from January 1,2013 to December 31,2016 in Tianjin Third Center Hospital were selected,retrieved,recorded and collate the general data.According to clinical observation and literature reports,65 factors that might affect postoperative complications and survival time were selected and recorded.The preoperative indexes included age,sex,height,weight,first symptoms,weight loss,smoking and drinking history,disease,basic disease,reduction of yellowing,leukocyte value,neutrophils ratio,absolute value of lymphocyte,bilirubin level,cholinesterase and prealbumin level,tumor markers,and tumor markers.Intraoperative indexes:ascites,tumor size,pancreatic duct support,Braun anastomosis,operation time,blood loss,blood transfusion,and total infusion.Postoperative indexes:liquid intake and output of the operation day,leukocyte,serum calcitonin,C reactive protein level on the 1st day and 3rd day after operation,feeding time,gastric tube time,somatostatin application,and biliary fistula,pancreatic fistula,gastroparesis,hemorrhage,abdominal infection,pulmonary infection,urinary infection,hospitalization days,readmission within 30 days,and whether two operations.The deadline of the follow-up was the time of death of the patient,and the case was in December 2017.163 patients were followed up effectively,with a follow-up rate of 80.30%.The follow-up content included recovery of normal life time,recurrence,metastasis,chemotherapy,biological therapy,and time of death.The data were processed statistically by SPSS19.0 software.According to the Clavien-Dindo complication classification system,for serious complications(III,IV,V)and two common complications,postoperative pancreatic fistula and abdominal infection:single factor,multiple factor analysis classification change The data were analyzed by chi square test 2,P<0.05,the difference was statistically significant.Statistical variables were introduced into Logistic regression model to identify independent risk factors.For 163 cases of effective follow-up,the Kaplan-Meier method was used to calculate the survival rate of 1 and 3 years,the median survival time and single factor analysis.The significant variables were introduced into the Cox stepwise regression model,and the independent factors affecting survival were determined.ResultsThe analysis of postoperative severe complications showed that postoperative bleeding,abdominal infection and delayed gastric emptying(P<0.05)are independent risk factors for postoperative serious complications.In addition,abdominal infection is an independent risk factor for postoperative pancreatic fistula(P<0.05).Pancreatic fistula and hospital stay>20 days were independent risk factors for postoperative abdominal infection(P<0.05).The overall median survival time was 39±4.60 months.The overall cumulative 1 year survival rate was 80.3%,and the 3 year survival rate was 50.1%.Age,serum sugar antigen 19-9,the level of the expression of carcinoembryonic antigen,the proportion of neutrophils before operation,the history of drinking,the first symptom,the amount of blood loss in the operation,and the quality of the pancreas(P<0.05)were all influencing factors of the survival time after the operation.The history of drinking and the level of serum CA19-9 were independent factors affecting the survival time.ConclusionFor postoperative pulmonary infection,postoperative bleeding,postoperative abdominal infection,and gastric emptying delay,early attention should be paid to the preoperative assessment,intraoperative prevention,postoperative vigilance,and early strengthening of the treatment plan,so as to reduce the incidence of severe complications after PD.To strengthen the nutritional support of the patients,improve the liver function,reduce the level of bilirubin,improve the resistance of the patients,guard against the postoperative pancreatic fistula and abdominal infection,avoid the mutual influence of the two,and cause serious consequences.The history of drinking and serum CA19-9 are independent risk factors for the long-term survival of periampullary and pancreatic cancer.Limiting alcohol consumption may improve the long-term prognosis after PD,and the increase of CA19-9 often means poor long-term survival.