Analysis Of Risk Factors For Pancreatic Fistula After Radical Gastrectomy

Objective:Gastric carcinoma is a common malignant tumour in the digestive system with a very high incidence in China,which seriously endangers people's health.Although radiotherapy and chemotherapy have made great progress in the treatment of gastric carcinoma,surgery is still the main method for the treatment of gastric carcinoma,among which D2 lymph node dissection has become the standard operation for locally advanced gastric carcinoma worldwide.However,due to the complex operation of stomach,the wide range of lymph node dissection,and the elderly,malnutrition and poor general condition of most patients,the postoperative complications are relatively common.Pancreatic fistula is one of the common complications after gastric carcinoma surgery,which often leads to serious consequences,such as disturbance of water electrolyte and acid-base balance,massive hemorrhage,abdominal infection and second operation.Therefore,the prevention and treatment of pancreatic fistula after gastric carcinoma surgery is one of the important topics in the field of surgery.The purpose of this study is to explore the risk factors of pancreatic fistula after radical operation for carcinoma of stomach,so as to provide theoretical basis for the rational management of patients undergoing radical operation for carcinoma of stomach during perioperative period,and to reduce the incidence of pancreatic fistula.Methods:A total of 396 cases of radical gastrectomy in the Department of Gastrointestinal Surgery,Affiliated Hospital of Qingdao University from Jun 2016 to Jun 2018 were collected.According to clinical experience and literature review,this study included the following indicators:age,gender,visceral fat area(Visceral Fat Area,VFA)?preoperative general conditions(such as history of abdominal surgery,occurrence of diabetes,albumin levels)?operation time?surgical approach?surgical incision path?TNM staging?drainage fluid amylase concentration of the first day after surgery,treatment of postoperative pancreatic fistula.Patients were divided into postoperative pancreatic fistula group(case group)and non-pancreatic fistula group(control group)according to diagnostic criteria.Statistical analysis was performed using SPSS19.0.Univariate analysis of statistically significant variables were included in the logistic multivariate analysis model to analyze the risk factors for pancreatic fistula after radical gastrectomy.P<0.05 was considered statistically significant.Results:A total of 396 patients with radical gastrectomy were enrolled,and the operation was performed smoothly.21 cases had postoperative pancreatic fistula.All patients were cured by adequate drainage,banned diet and gastrointestinal decompression,medications that inhibit pancreatic secretion,anti-infectives,and intravenous nutritional support.Univariate analysis results showed that gender(?~2=1.017,P=0.313),age(t=0.726,P=0.468),history of abdominal surgery(?~2=0.026,P=0.872),history of diabetes(?~2=2.080,P=0.149),surgical incursion path(?~2=0.001,P=0.980),surgical approach(?~2=0.139,P=0.710),pathological staging(?~2=1.385,P=0.500),difference was not statistically significant(P>0.05).Visceral fat area(?~2=6.879,P=0.009),BMI(t=8.272,P=0.024),operation time(t=2.253,P=0.025),lymph node dissection(t=3.493,P=0.001);the albumin on the 2nd to 4th day after operation(t=-2.485,P=0.013)was related with pancreatic fistula after radical resection of gastric cancer(P<0.05).Including the single factor P<0.05 variable into multivariate logistic regression analysis and it showed that the visceral fat area(OR=1.920,P=0.003)BMI(OR=2.020,P=0.024),lymph node dissection(OR=1.863,P=0.022),and operation time(OR=3.726,P=0.010),and serum albumin decrease on the2nd to 4th day after surgery(OR=0.808,P=0.018)were the risk factor of postoperative pancreatic.Conclusion:High BMI,excessive visceral fat area,multiple lymph node dissection,prolonged operative time,and decreased serum albumin on the 2nd to 4th postoperative days will increase the risk of postoperative pancreatic fistula.Dynamic monitoring of the amylase content of the drainage fluid after surgery is helpful for early prediction and diagnosis of pancreatic fistula.Smooth drainage,ban diet,gastrointestinal decompression,application of somatostatin,selection of spectral antibiotics,and use of double-supply can effectively treat postoperative pancreatic fistula in gastric cancer.