Prediction Of Pancreatic Fistula After Distal Pancreatectomy And Analysis Of Influencing Factors

Objective: To explore the various risk factors that affect the occurrence of postoperative pancreatic fistula(POPF)after pancreatic body and tail resection(DP).Methods: The clinical data of 114 patients who underwent DP in the Pancreatic Surgery of the First Affiliated Hospital of Xinjiang Medical University from June 2014 to June2019 were retrospectively analyzed.Collect preoperative data of surgical patients including gender,age,body mass index(BMI),history of diabetes,history of hypertension,smoking history,preoperative plasma albumin level,preoperative neutrophil / lymphocyte ratio(NLR),and Pre-prognosis nutrition index(PNI = plasma albumin + 5 x lymphocyte count).The pancreatic texture of the patient was queried by the surgical records,and the differentiation type and cTNM stage of the tumor patient were obtained according to the results of the routine pathological examination of the patient.Collect postoperative indicators of patients,including postoperative plasma albumin levels,postoperative NLR values,and postoperative PNI values.According to the presence or absence of postoperative pancreatic fistula(PF),the patients were divided into the POPF group and the non-POPF group.Results: In this study,43 patients(37.7%)developed PF after DP,including 19 biochemical fistulas and 21 grade B pancreatic fistulas Cases,3 cases of grade C pancreatic fistula.Univariate analysis results showed:BMI values,drinking history,plasma albumin levels before surgery,plasma albumin levels after surgery,neutrophil/lymphocyte ratio(NLR)values ??before surgery,preoperative There were significant differences in the prognostic nutrition index(PNI)and postoperative PNI values(P<0.05).Multivariate analysis results showed that:preoperative plasma albumin>35g/L[OR=0.119,95%CI was(0.039,0.363)],postoperative plasma albumin> 35g/L[OR=0.125,95%CI(0.030,0.511)] and postoperative NLR value ≤6.65 [OR=0.137,95%CI(0.043,0.436)] are both influencing factors for the occurrence ofPOPF after DP.Draw the receiver working curve(ROC curve)to get the area under the curve of BMI,postoperative NLR,preoperative PNI,postoperative PNI,preoperative plasma albumin,postoperative plasma albumin,and calculate the BMI based on the Youden index The best boundary point of NLR and PNI,according to the area under the ROC curve,the best prediction index can be obtained.Conclusion:Plasma albumin before and after surgery>35g/L and postoperative NLR value ≤6.65 are protective factors of POPF after DP,and the peripheral blood NLR value can be used as a predictor of POPF after DP.