Analysis Of Risk Factors For Pancreatic Fistula After Pancreaticoduodenectomy

Objective: To investigate the related risk factors for pancreatic fistula(PF)after pancreaticoduodenectomy(PD).Methods: Clinical datas of PD patients were admitted in Dalian Central Hospital Affiliated to Dalian Medical University from January 2009 to December 2018 and they were performed PD operation by a team of hepatobiliary-pancreatic surgeons.14 relevant clinical variables of 97 patients in our hospital were retrospectively analyzed,among which Independent Sample t Test was adopted for continuous variables(age,preoperative liver function,etc.),and Chi-square Test was adopted for dichotomous variables(BMI,MPD,etc.).Data of variables with statistical significance were selected from univariate analysis and analyzed by SPSS22.0 software.Independent risk factors and OR of pancreatic fistula were calculated by Logistic multivariate analysis:OR=Exp(B).The test level was =0.05,and p < 0.05 was considered statistically significant.Results: In this study,there were 31 cases of pancreatic fistula after PD in 97 patients,including 19 patients of biochemical fistula(19.6%),28 patients of B grade PF(28.9%)and 3 patients of C grade PF(3.1%)in POPF and 47 patients without PF(48.4%).Among the 97 patients,4 patients died due to perioperative postoperative abdominal bleeding and multiple organ failure after reoperation,with a total mortality rate of 4.1%.Among the 4 patients,3 had postoperative abdominal bleeding due to C grade PF,and the other 1 was non-PF.Therefore,among 31 patients with PF,3 patients died after perioperative period,with a mortality rate of 9.7%.1 patient dead among 66 patient in the non-PF group,with a mortality rate of 1.5%.The mortality rate of PF group was 6.6 times than that of non-PF group,2.4 times than that of the total.Univariate analysis suggested that the incidence of pancreatic fistula after pancreaticoduodenectomy was not related to the patient's age,gender,preoperative liver fuction,preoperative bilirubin level(umol/L),preoperative albumin level(g/L),whether preoperative biliary drainage,postoperative pathology(benign or malignant),tumor site,intraoperative blood loss(ml)and operation time(min)(p > 0.05),but related to the texture of the pancreas,diabetes,main pancreatic duct diameter(mm)and BMI(kg/?)(p<0.05).Logistic multivariate analysis showed that the soft pancreas,MPD?3 mm and BMI?25kg/? were independent risk factors for postoperative pancreatic fistula(p<0.05).Conclusion: Pancreatic texture,diabetes,MPD and BMI were risk factors for pancreatic fistula(POPF)after pancreaticoduodenectomy.Soft pancreas(OR=5.160,p=0.018),MPD ? 3 mm(OR=4.509,p=0.029)and BMI ? 25 kg / ?(OR=3.066,p<0.01)are independent risk factors for postoperative pancreatic fistula.