| Background:Pancreaticoduodenectomy,one of the most complicated operations in abdominal surgery,has also been one of the achievements of hepatobiliary and pancreatic surgeons eager to unlock.Since Gagner reported the first case of Laparoscopic Pancreaticoduodenectomy(LPD)in 1994.Laparoscopic pancreaticoduodenectomy has minimally invasive advantages such as clear field,less bleeding,postoperative inflammatory response,rapid postoperative recovery,short hospitalization,and with laparoscopic instruments,perioperative management and surgery With the continuous development of technology,LPD has gradually become a safe and feasible routine for major medical centers in recent years.However,studies have shown that laparoscopic pancreaticoduodenectomy and open pancreaticoduodenectomy(OPD,Open Pancreaticoduodenectomy)are comparable in the incidence of postoperative complications,up to 30% to 50%.The occurrence of postoperative complications often means the extension of the patient's hospitalization period and the increase in hospitalization costs.Clinically,the most relevant postoperative complication of LPD is pancreatic fistula(PF),which is usually associated with life-threatening complications such as Abdominal abscess,early or delayed bleeding,requires reoperation and death.Since our team started laparoscopic pancreaticoduodenectomy in 2014,we gradually accumulated experience and proposed the team's “en-block” resection procedure.This study retrospectively analyse the risk factors for major perioperative complications of these 176 case,and establish a predictive model of postoperative pancreatic fistula,screening high-risk patients for early prevention and intervention,in order to reduce of postoperative complications is improved,the safety of surgery is improved,and the prognosis of patients is improved.ObjectiveTo explore the risk factors for overall complications after laparoscopic pancreaticoduodenectomy and postoperative pancreatic fistula.Through the establishment of postoperative pancreatic fistula risk prediction model,screened the high-risk patients to early active intervention and correction.Ensure the safety of surgery and improve the prognosis of patients.MethodsRetrospective analysis of the clinical data of 176 patients undergoing laparoscopic pancreaticoduodenectomy from January 2014 to January 2019.To explore the relationship between various factors and postoperative complications by univariate and multivariate analysis.Putative risk factors were divided into three broad categories: 1)patient-related factors,such as age,gender,BMI,Hypertension Diabetes,history of abdominal surgery,jaundice,diameter of pancreatic duct;2)surgery-related: fhtors,such as operating time of pancreaticojejunostomy,estimated blood loss,intraoperative blood transfusions;3)disease-related factors,such as resectable or borderlineresectable,size.Based on the multivariate analysis of patients to establish a clinical risk prediction model by logistic regression equation.ResultsFrom January 2014 to January 2019,our team completed 176 cases of laparoscopic pancreaticoduodenectomy.the 30-day in hospital death occurred in one patient(grade C pancreatic fistula,abdominal abscess with hemorrhage),5 patients underwent reoperation(1 case of superior mesenteric venous hemorrhage,2 cases of gastric duodenal artery hemorrhage,gastrointestinal anastomotic hemorrhage)1 case,grade C pancreatic fistula,abdominal abscess combined with hemorrhage in 1 case).There were 73 patients(41.5%)with total complications;17 patients(9.7%)had serious postoperative complications(C-Dgrade?III);30 patients(17.0%)with total pancreatic fistula,including 17 patients(9.7%)with biochemical leaks,for the clinical pancreatic fistula,There were 10 cases(5.7%)of grade B pancreatic fistula,3 cases(1.7%)of grade C pancreatic fistula;16 cases(9.1%)of postoperative hemorrhage;10 cases(5.7%)of bile leakage;6 cases of abdominal infection(3.4);4 cases of wound infection(both incision in the lower abdomen specimens)(2.2%);4 cases of pulmonary infection(2.2%);3 cases of gastric emptying disorder(1.7%);the average operation time was 326.0±55.6min.The average time of resection was(174.0±42.5)min;the mean time of reconstruction was(101±21.4)min;the mean time of pancreaticojejunostomy was(40.0±8.7)min;the mean time of gastrointestinal anastomosis was:(26±5.5)min;The mean time was:(24±6.5)min;the mean intraoperative blood loss was(176±41)mL,the tumor diameter was(2.3±1.3)cm,and the number of lymph node dissection was(16.7±4.2),of which the positive lymph node was(1.3± 1.1),the average length of hospital stay was 14.8(8~29)days.The risk factors for postoperative overall complications were age ? 65 years,intraoperative blood loss ? 200,and diabetes mellitus were risk factors for overall postoperative complications of LPD.The risk factors for postoperative clinical pancreatic fistula complications were age ? 65 years,male,pancreas duct diameter?3cm,pancreas texture.A predictive model was established based on clinical pancreatic risk factors,and the area under the ROC curve was 0.893.ConclusionsLPD as a routine procedure is safe and feasible in a team with extensive laparoscopic experience.Age,intraoperative blood loss,and diabetes mellitus were risk factors for overall postoperative complications of LPD;age,male,pancreatic duct diameter and pancreas texture were risk factors for pancreatic fistula after LPD.Despite the limitations,the postoperative pancreatic fistula prediction model established in this study has a good predictive performance and can predict the risk of postoperative pancreatic fistula,which will help early prevention and intervention in perioperative period.Improve surgical safety. |
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