| Objective This study was designed to analyze the incidence of pancreatoduodenectomy complications around the ampulla and the risk factors for postoperative pancreatic fistula,investigate the relationship between severe complications and prognosis after pancreaticoduodenectomy and analyze independent risk factors affecting overall survival with clinical data.Methods A retrospective case-control study was used.The clinical data of 161 patients with periampullary carcinoma undergoing pancreaticoduodenectomy were collected from the first and second affiliated hospital of Anhui Medical University from January2014 to December 2017.The related risk factors affecting the occurrence of postoperative pancreatic fistula were analyzed by univariate and multivariate analysis.Log Rank and Cox regression methods were used to analyze survival data.Kapland-Meier was used to draw the survival curve.Results There were 4 deaths in 161 cases,the postoperative mortality rate was 2.5%,and 1 cases were directly related to postoperative pancreatic fistula.The incidence of complications after pancreatoduodenectomy was 62.1%(100/161),and the rate of postoperative pancreatic fistula was 20.5%(33/161),of which class B pancreatic fistula was 19.3%(31/161)and class C pancreatic fistula was 1.2%(2/161).The univariate and multivariate analysis results showed that the pancreatic duct diameter was ?3mm(OR=0.331,95 %CI=0.122-0.893,P=0.029),and the pancreas was soft(OR=0.628,95 %CI=0.398-0.992,P=0.046)and postoperative albumin ?30g / l(OR=0.327,95 %CI=0.142-0.752,P=0.009)are the three independent risk factors for pancreatic fistula after operation.A total of 113 follow-up data were finally included.The incidence of pancreatic fistula after operation was 15.9%(18/113),and the incidence of severe complications CD3-4 was 12.4%(14/113).The median follow-up time was 661 days(30-1565 days),and the median survival time was 764 days(613.47 days-914.53 days).The overall survival rates at 1 year,2 years,3 years,and 4 years after pancreaticoduodenectomy were 79.6%,51.4%,30.6%,and 30.6%,respectively.Univariate analysis showed that tumor differentiation,age,tumor origin,and total bilirubin before surgery were related to overall survival(c2=19.066,4.235,9.798,8.713,p<0.05).The 4-year survival rates in the CD1-2 and CD3-4 groups were 31.8%and 35.7%(c2=3.417,p=0.065);the 4-year survival rates in the pancreatic fistula and non-pancreatic fistula groups were 33.5,% and 29.9%(c 2=1.346,p=0.246),respectively.,the difference was not statistically significant.Multivariate analysis results showed that poorly differentiated tumors(OR = 2.274,95% CI = 1.500-3.447,p = 0.000)and tumor origin(OR = 0.766,95% CI = 0.602-0.976,p = 0.031)were affecting overall survival Independent risk factors.Conclusion 1.The overall complication rate after pancreatoduodenectomy was 62.1%,the serious complication rate was 11.8%,and the pancreatic fistula rate was 20.5%.Pancreatic duct diameter ?3mm,soft pancreas and postoperative albumin ?30g / l are independent risk factors for postoperative pancreatic fistula.2.Postoperative pancreatic fistula does not affect long-term survival,but it prolongs the length of hospital stay and increases medical costs.3.Severe complications after pancreatoduodenectomy for periampullary cancer do not affect long-term survival after surgery,and the origin and degree of differentiation of the tumor are independent risk factors that affect overall survival after pancreatoduodenectomy. |
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