Risk Factors For Pancreatic Fistula After Laparoscopic Pancreaticoduodenectomy

Objective: The preoperative,intraoperative and postoperative factors of patients undergoing laparoscopic pancreaticoduodenectomy(LPD)for various diseases in our hospital were analyzed to explore the risk factors of postoperative pancreatic fistula after LPD.Methods: a retrospective control study was conducted to include the clinical data of 165 patients with LPD who underwent hepatobiliary surgery in hunan provincial people's hospital from January 2015 to January 2018 according to the inclusion and exclusion criteria.Data of postoperative pancreatic fistula,hemorrhage,infection,biliary fistula,gastrointestinal dysfunction,postoperative hospitalization time,secondary operation rate,multi-organ failure and mortality were collected for general analysis.Pancreatic fistula(grade B or C)was divided into the pancreatic fistula group and the non-pancreatic fistula group,and the relevant factors of pancreatic fistula were compared and analyzed.Relevant factors include gender,age,body mass index,diabetes mellitus,hypertension,preoperative albumin,total bilirubin,preoperative,operative time,blood loss,blood transfusion or not,the abdominal cavity drainage tube placement number,pancreatic anastomosis way,pancreas,pancreatic duct diameter size texture,supporting tube inside and outside the drainage of the pancreatic duct,postoperative drainage fluid on the first day of amylase value,drainage fluid volume on the first day after operation,postoperative serum amylase value,postoperative pathological types.Univariate analysis was performed for each factor one by one using statistical software,and univariate analysis had statistical significance(P<0.05)were further analyzed by multivariate Logistic regression model.Results: were included in this study,165 patients who underwent LPD postoperative complications: B,C,pancreatic fistula,16 cases(9.7%),hemorrhage in 30 cases(18.2%),25 cases(15.2%)of infection,biliary fistula 4 cases(2.4%),gastrointestinal dysfunction in 13(7.9%),12 cases were secondary surgery(7.3%),multiple organ failure in 3 patients(1.8%),30 d,3 cases died(1.8%),the average hospitalization time 18.7 d(8-70-d).The comparison between pancreatic fistula and non-pancreatic fistula group showed that there was no statistical difference between pancreatic fistula and postoperative biliary fistula and gastrointestinal dysfunction,but there were statistical differences between pancreatic fistula and postoperative bleeding,infection,multi-organ failure,secondary operation rate and postoperative hospitalization time(p<0.05),and the incidence was significantly increased.Univariate analysis showed that preoperative total bilirubin,operative time,main pancreatic duct diameter,pancreatic texture,and the value of amylase in the drainage fluid on the first day after surgery may be risk factors for pancreatic fistula after LPD.Multivariate analysis showed that pancreatic duct diameter less than 3mm was an independent risk factor for pancreatic fistula after LPD.Conclusions:1.Pancreatic fistula after LPD is associated with postoperative bleeding and infection complications,which increases the rate of reoperation and significantly extends the length of hospital stay.2.Preoperative total bilirubin,operative time,main pancreatic duct diameter,pancreatic texture,and the value of amylase in the drainage fluid on the first day after surgery may be risk factors for pancreatic fistula after LPD.3.The main pancreatic duct diameter less than 3mm is an independent risk factor for grade B and grade C pancreatic fistula after LPD.