Study Risk Factors For Hemorrhage After Laparoscopic Pancreaticoduodenectomy

Objective:The pancreaticoduodenal resection(pancreaticoduodenectomy,PD)as a treatment for common bile duct under section of the malignant tumor,pancreas tumor,and some of the ampulla around the preferred treatment operation for benign and malignant diseases.With minimally invasive Laparoscopic technique in clinical application of Laparoscopic pancreatic duodenal resection(Laparoscopic pancreaticoduodenectomy,LPD)has been extensively developed,and its high technical difficulty,complex operation and removal of organs,anastomotic postoperative complications and more complex,postoperative bleeding is one of the serious complications,analyze the cause of hemorrhage after Laparoscopic resection of pancreas duodenum and the corresponding treatment,reduce the risk of postoperative hemorrhage and incidence of benefit more patients,thereby reducing patients postoperative mortality?Methods: Retrospective analysis was conducted to collect clinical data of 228 cases of laparoscopic pancreaticoduodenectomy performed in hepatobiliary and pancreatic surgery department of the second hospital of hebei medical university from January 2015 to December 2017.Among the 228 cases,the data were divided into bleeding group and non-bleeding group.Routine preoperative preparation: plasma albumin higher than 35g/L was corrected for patients with low protein before surgery.The corrected anaemic hemoglobin should be higher than 70g/L,the blood pressure of hypertension patients should be controlled below 160/100 mmhg,the blood glucose of diabetes patients should be well controlled,the cardiopulmonary function of patients should be strictly monitored and dealt with,and smoking patients should be banned for 2 weeks.Patients with preoperative bilirubin value higher than 176umol/L were treated with percutaneous transhepatic biliary catheter drainage(PTCD)or endoscopic retrograde nasobiliary drainage(ERCP)for yellowed treatment,and their bilirubin value lower than 176umol/L were treated with elective surgery.The data were analyzed and analyzed by univariate analysis of preoperative studies including gender,age,BMI(kg/m2),biliary drainage,diabetes,hypertension and total bilirubin level.Intraoperative study: operative time(min),intraoperative blood loss(>=500ml),intraoperative blood transfusion(>=500ml).Postoperative complications: for pancreatic fistula(grade B/C the pancreatic fistula),biliary fistula,gastrointestinal fistula,abdominal cavity infection,pulmonary infection,the use of statistical software SPSS22.0 single factor analysis,and then to the single factor correlation index(P < 0.05 for Logistic multi-factors analysis retrospectively independent risk factors of postoperative bleeding,explore after laparoscopic resection of pancreatic duodenal bleeding related risk factors and treatment measures?Results: According to the clinical statistics,among the 228 patients,there were 26 cases of bleeding(11.4%)and 202 cases of non-bleeding,132 cases of male patients(57.8%),14 cases of bleeding group and 118 cases of non-bleeding,96 cases of female patients(42.8%),12 cases of bleeding group and 84 cases of non-bleeding.The patients were 27 to 89 years old,with an average age of 60.04 years.Postoperative clinicopathological data showed: 82 cases of cholangiocarcinoma(35.9%),13 cases of chronic pancreatitis(5.7%),67 cases of duodenal cancer(29.3%),65 cases of pancreatic cancer(28.5%),and 1 case of autoimmune pancreatitis.Among the 228 cases,26 cases(11.4%)had postoperative hemorrhage,including 1 case of upper gastrointestinal hemorrhage and 25 cases of abdominal hemorrhage,17 cases(7.4%)of which had undergone reoperation for hemostasis.Most of the bleeding points identified during the operation could be completely hemostasis,including 4 cases of death(1.7%)and 1 case of improvement after conservative treatment with fluid rehydration.Endoscopic hemostasis was performed in 1 case,family members were discharged automatically in 1 case,and vascular interventional embolization was applied in 1 case.The incidence of postop-erative pancreatic fistula was 10.08%(23/228)in the pancreatic fistula group(n = 23),60.08%(14/23)in the hemorrhagic group,21.73%(5/23)in the non-hemorrhagic group(n = 5),about 2.8 times(n = 23)in the hemorrhagic group.Postoperative abdominal infection was found in 32 cases(14.0%).There were 19 cases of abdominal infection in the hemorrhage group(59.3%,19/32),and 13 cases of abdominal infection in the non-hemorrhage group(40.6%).Patients were divided into postoperative bleeding group and non-bleeding group according to whether there was postoperative bleeding.There were 26 cases in the bleeding group and 202 cases in the non-bleeding group.1.Univariate analysis was conducted according to the statistical preoperative conditions: gender,age,BMI(kg/m2),biliary drainage,diabetes,hypertension,preoperative ALB,total bilirubin,etc.The statistical comparison results showed that P > 0.05,and the preoperative general conditions were not statistically significant.2.The intraoperative situation: grouping bleeding,bleeding group by statistical operation time(min),intraoperative blood loss(> = 500 ml),intraoperative blood transfusion volume(> = 500 ml),by comparison with statistical results show that the amount of intraoperative blood transfusion(P < 0.05),statistically significant,may have correlation with postoperative bleeding,and then using the multi-factor Logistic review of clinical data of all variables model analysis found that intraoperative blood transfusion volume in bleeding group with no statistical difference between the hemorrhage group than the independent risk factors of postoperative bleeding.3.Postoperative situation analysis: univariate statistical analysis was performed for common postoperative complications: pancreatic fistula(grade B/C pancreatic fistula),biliary fistula,gastrointestinal fistula,abdominal infection,pulmonary infection,etc.,indicating that pancreatic fistula(grade B/C pancreatic fistula)and abdominal infection presented statistical significance between the bleeding group and the non-bleeding group(P < 0.05).Furthermore,multivariate Logistic review model analysis of all the variables in clinical data showed that postoperative pancreatic fistula and abdominal infection were also statistically different between the bleeding group and the non-bleeding group,indicating that they were independent risk factors for postoperative bleeding.Postoperative pancreatic fistula or abdominal infection will increase the probability of postoperative bleeding.Conclusions:1.In this study,postoperative pancreatic leakage and abdominal infection were independent risk factors for postoperative hemorrhage after laparoscopic pancreaticoduodenectomy.2.The amount of blood transfusion(> =500ml),and pulmonary infection may be associated with postoperative bleeding,is its risk factors,but not its independent risk factors.The intraoperative transfusion volume was reduced by improving the operative technique to reduce the intraoperative blood loss.