Clinical Comparative Study Of Pancreaticoduodenal Drainage And External Drainage In Pancreaticoduodenectomy And Related Risk Factors Of Pancreatic Fistula

Objective:By comparing the clinical data of pancreaticoduodenectomy with that of pancreatic duct supporting internal drainage and external drainage,the clinical application value of pancreatic duct supporting internal drainage and external drainage was discussed,and the risk factors of pancreatic fistula in pancreaticoduodenectomy with pancreatic duct supporting drainage were analyzed.Methods:Retrospective analysis was performed to collect the clinical data of 67 patients undergoing pancreaticoduodenectomy in the Department of Hepatobiliary Surgery,Second Affiliated Hospital of Kunming Medical University from August 2016 to November 2018.In all patients,intraoperative pancreatic duct drainage was performed with a supportive tube with the same diameter as the pancreatic duct.Divided into pancreatic duct support tube drainage group(group A)and support tube extermal drainage group(group B)a total of 2 groups,pancreatic duct support tube drainage 32 cases(47.8%),pancreatic duct support tube drainage 35 cases(52.2%).Through the preoperative corresponding indicators(such as age,jaundice,albumin level,body mass index,hemoglobin,diabetes,heart disease,high blood pressure,etc.),intraoperative indicators(surgery time,intraoperative blood loss,intraoperative blood transfusion,Disease properties,pancreatic duct diameter,pancreatic texture,postoperative venting time,etc.,postoperative related indicators(postoperative complications,postoperative pancreatic fistula,biliary fistula,gastrointestinal or intestinal anastomotic leakage,abdominal abscess,digestion)The difference analysis of bleeding,lung infection,wound infection,average postoperative hospital stay,hospitalization expenses,etc.,explored the clinical application value of drainage and drainage in the pancreatic duct.Results:1.General clinical data:38 males and 29 females;aged 47-75 years old,average(59.06±7.71)years old.There were 21 cases of duodenal papillary carcinoma,15 cases of pancreatic head cancer,12 cases of lower bile duct cancer,16 cases of periampullary carcinoma,and 3 cases of pancreatic head inflammatory pseudotumor.According to the pancreatic duct anastomosis,the drainage of the pancreatic duct was divided into the pancreatic duct support tube drainage group(group A)and the pancreatic duct support tube drainage group(group B).There was no significant difference in the general clinical data between the two groups(P>0.05),which was comparable.2.Comparison of surgical related indexes:There was no significant difference in the operation time,intraoperative blood loss,intraoperative blood transfusion and postoperative exhaust time between group A and group B(P>0.05).3.Postoperative complications:30 patients in group A and B had postoperative complications(postoperative pancreatic fistula,namely POPF,biliary fistula,abdominal abscess,abdominal or digestive tract bleeding,lung infection,wound infection,etc.),overall incidence 44.7%,the total incidence of postoperative complications in group A was 43.7%,and the total incidence of postoperative complications in group B was 45.7%.The difference was not statistically significant(P>0.05).In group A and group B,18 cases(26.8%)had pancreatic fistula,including 8 cases of grade A pancreatic fistula(11.9%)and 10 cases of grade B and C pancreatic fistula(14.9%).The statistics of complications in group A and B showed that in group A,8 cases(25%)had pancreatic fistula,1 case(1%)of abdominal abscess,3.1%of incision infection,and 1 case of gastric fistula(3.1%).After conservative treatment with ultrasound puncture and drainage,1 case of pulmonary infection(3.1%),1 case of gastrointestinal bleeding(3.1%),reoperation after transfusion to correct anemia,no biliary,intestinal anastomosis In group B,10 cases(28.6%)had pancreatic fistula after operation,and 1 of them was pancreatic fistula after extubation.After nutritional support,somatostatin,and maintenance of abdominal drainage,biliary fistula,abdominal abscess,wound infection,and two cases of biliary and incision infections.(5.7%),one case(2.8%)of pulmonary infections and abdominal abscess,patients with abdominal abscess were cured by ultrasound-guided abscess puncture drainage,and wound infection and pulmonary infection were cured after conservative treatment.4.Average postoperative hospital stay and hospitalization expenses:The average hospital stay in group A(10.66±2.38)days,and the average hospital stay in group B(14.17±3.08)days,(P<0.05)The difference is statistically significant.Group A hospitalization expenses(37.9±2.4)million yuan,group B hospitalization expenses(42.0±4.4)million yuan,(P<0.05),the difference was statistically significant.Conclusions:1.There was no significant difference in the index of operation between the pancreatic duct and the external drainage in the pancreaticoduodenectomy.There was no significant difference in the incidence of postoperative complications.The average hospitalization time after drainage in the pancreatic duct support tube is less than that of the pancreatic duct support tube.The hospitalization cost is lower than that of the pancreatic duct support tube,which has certain promotion value in clinical practice.2.Among the risk factors affecting postoperative pancreatic fistula,operative time and body mass index BMI were risk factors for overall POPF in PD with pancreatic duct support tube.Pancreatic textxure and pancreatic duct diameter were overall POPF and clinically significant risk factors for POPF.