Analysis Of Factors Affecting Delayed Gastric Emptying After Pancreaticoduodenectomy

Objective This study collects and collates the case data of patients undergoing pancreaticoduodenectomy(PD)in our hospital.Referring to the domestic and foreign research data,we analyze the influence of various factors on the delayed gastric emptying(DGE)after PD,and then analyze its possible mechanism,so as to provide reference for clinicians to reduce the incidence of DGE after PD.Methods This study retrospectively analyzed the medical records of patients undergoing pancreaticoduodenectomy(PD)from January 2014 to December 2018 in the Department of Hepatobiliary Surgery,General Hospital of Ningxia Medical University.Preoperative factors such as gender,age,hypertension,diabetes,gastric diseases,preoperative yellowing,preoperative bilirubin,preoperative alanine aminotransferase(ALT)and so on were analyzed.Postoperative factors such as operation mode(PD,PPPD,Braun anastomosis,gastrointestinal anastomosis before colon),pancreatic duct diameter,pancreatic duct stent,postoperative complications(pancreatic fistula,biliary fistula,anastomotic fistula,chylous leakage,abdominal infection,postoperative hemorrhage),postoperative pathology(with or without lymph node metastasis)and hospitalization time and medical expenses were analyzed statistically.The counting data were tested by χ2 test or Fisher exact test with SPSS17.0 software,and the non-normal data were analyzed by rank sum test.Then the "Logistic" regression model was established;the standard of entering the equation was 0.05,and the standard of eliminating the equation was 0.10;P < 0.05 was the significant difference,so as to determine the independent risk factors leading to DGE after PD.Results Univariate analysis showed that there was no significant difference in the related factors;then all possible factors were included in the logistic regression model for multivariate analysis.The results showed age(P=0.007,OR=23.66),preoperative alanine aminotransferase(ALT)(P=0.033,OR=0.335),lymph node metastasis(P=0.005,OR=4.358)and anastomotic leakage(P=0.041,OR=11.731).There was significant difference in DGE between the two groups,which was an independent risk factor for DGE after PD.The median hospitalization time of patients without DGE after PD was 18±10 days,and that of patients with DGE was 25±12 days.There was significant difference between the two groups(P < 0.05).As for medical expenses,the median medical expenses of DGE-free patients and DGE-free patients were 107117.58 ± 45459.69 yuan and 121105.18 ± 45252.45 yuan,respectively.There was also a significant difference between the two groups(P=0.008).Conclusion Age,preoperative ALT,anastomotic leakage and lymph node metastasis were independent risk factors for DGE after PD.Although DGE is not life-threatening,it is a disgusting complication,which can lead to serious discomfort,prolong hospitalization time,seriously affect the quality of life,thereby increasing the economic burden of patients and society.