The Study Of The Related Factors With Development Of Clinically Relevant Pancreatic Fistula After Laparoscopic Pancreatoduodenectomy

Objective:To determine the related factors with development of clinically relevant pancreatic fistula after laparoscopic pancreatoduodenectomy(LPD).Method:The study retrospectively 149 patients undergoing laparoscopic pancreaticoduodenectomy in our department from October 2013 to September 2018.According to the diagnostic criteria for clinically relevant pancreatic fistula:Any amount of drainage fluid amylase concentrations higher than the upper limit of normal serum amylase concentrations more than three times after postoperative 3 days,at the same time has a corresponding clinical manifestations,the patients were divided into pancreatic fistula group and non pancreatic fistula group.Clinical data were collected,including patient' s gender,age,Body Mass Index(BMI),past history,personal history,pre-operative laboratory results,preoperative percutaneous trans transhepatic cholangial drainage(PTCD)treatment,anesthesia classification,length of surgery,amount of intraoperative blood loss,whether the diameter of the pancreatic duct is greater than or equal to three millimeters,pancreas texture,postoperative use of Evodia rutaecarpa hot compress,pathological diagnosis results;At the same time,to observe the complications(gastric emptying disorder,biliary fistula,postoperative bleeding,abdominal infection),record the first anal exhaust time,postoperative feeding time,postoperative hospital stay time.Meanwhile,single factor analysis was conducted on related factors which might cause pancreatic fistula.Then further logistic multi-factor regression analysis would be carried out the related factors for development of the pancreatic fistula and analysis of the effect of clinical pancreatic fistula on postoperative prognosis.Results:There were 149 patients enrolled in this study,According to result of univariate analysis t test or x2 test,BMI,history of smoking,the diameter of the pancreatic duct,pancreas texture,postoperative use of Evodia rutaecarpa hot compress,postoperative bleeding,abdominal infection the,first anal exhaust time,postoperative hospital stay time,hospital costs were statistically significant related to the pancreatic fistula(P<0.05=,while there were no significant difference in patient' s age,gender,history of past illness,drinking history,pre-operative laboratory results,preoperative PTCD treatment,length of surgery,amount of intraoperative blood loss,pathological diagnosis results,the complications(gastric emptying disorder,biliary fistula,postoperative bleeding,abdominal infection),postoperative feeding time of the two groups(P>0.05).The results of the multivariate binary logistic regression analysis showed that soft pancreas,smoking history,high BMI,pancreatic duct diameter less than 3 mm were determined as risk factors for the development of clinically relevant pancreatic fistula after laparoscopic pancreatoduodenectomy(LPD).The postoperative use of Evodia rutaecarpa hot compress can reduce the risk of the development of clinically relevant pancreatic fistula after laparoscopic pancreatoduodenectomy(LPD).Conclusion:The soft pancreas,smoking history,high BMI,pancreatic duct diameter less than 3 mm were determined as risk factors for the development of clinically relevant pancreatic fistula after laparoscopic pancreatoduodenectomy(LPD).The postoperative use of Evodia rutaecarpa hot compress can reduce the risk of the development of clinically relevant pancreatic fistula after laparoscopic pancreatoduodenectomy(LPD).