Analysis Of Preoperative CT In Predicting Pancreatic Fistula After Pancreaticoduodenectomy

Object Through the comprehensive analysis of the preoperative CT(CT)scanning data of(PD)patients undergoing pancreaticoduodenectomy,it is expected to find out the effective index which can predict the postoperative pancreatic fistula before operation.Methods The clinical data of 230 patients who underwent pancreaticoduodenectomy in the people's Hospital of Zhengzhou University from January 2013 to January 2018 were analyzed retrospectively.they were divided into pancreatic fistula group and non-pancreatic fistula group.CT indexes were collected from two groups,including pancreatic duct width,pancreatic thickness,pancreatic index,abdominal fat thickness,pancreatic CT value(non-intensive)(N),arterial(A),There were 17 variables such as CT value and ratio of(P)in portal vein phase and(L)in delayed phase.In addition,the general indexes such as sex,age,BMI,diabetes mellitus,preoperative bilirubin and preoperative albumin were collected to analyze the correlation between each index and pancreatic fistula.All data were analyzed by SPSS22.0 statistical software,and Fisher accurate test(classified variable)and Mann-Whitney U test(continuous variable)were used to evaluate the significance of the difference between the two groups.For statistically significant indicators,draw the working curve of the subjects(ROC),to calculate the area under the curve(AUC)and other indicators to find out the best threshold for the prediction of postoperative pancreatic fistula.ResultsPancreatic fistula occurred in 32 of the 230 patients,with a pancreatic fistula rate of 13.91%.The analysis of general indexes showed that there were significant differences in BMI,preoperative albumin,pancreatic texture and pathological types between the two groups.There was no statistical significance in sex,age,diabetes,hypertension,preoperative total bilirubin,intraoperative blood loss,blood transfusion and operation time.11 of the CT variables were significantly correlated with pancreatic fistula.the thickness of abdominal wall fat,the ratio of pancreatic and spleen CT value,pancreatic width,pancreatic duct width,P and L were significantly lower than those in the group without pancreatic fistula.The pancreatic index,N,A,P and P were significantly higher than those of non-POPF,.By drawing the working curve of the subjects,it was found that the pancreatic index and A / P ratio had the largest area under the working curve(AUC:0.868,p=0.07;).AUC:0.811,p < 0.001),when the cut-off point of pancreatic index was 0.15,the sensitivity was 82.2%,the specificity was 77.1%,the predictive efficacy was the highest,and the A cut-off point was 1.19.The sensitivity was 84.7%,the specificity was 80.4%,and the predictive efficacy was the highest.There was no significant difference in the ratio of liver and spleen CT value,portal vein system invasion,spleen CT value,liver CT value,periumbilical abdominal circumference and A / N ratio between the two groups.Conclusion It is feasible to predict the risk of pancreatic fistula in patients after PD by preoperative CT index.It is found that pancreatic index and A / P have the maximum predictive effect.At the same time,the width of pancreatic duct,the ratio of CT value of pancreas and spleen and the ratio of P to L were closely related to pancreatic fistula after pancreaticoduodenectomy.