Analysis Of Risk Factors For Early Biliary Complications After Pancreaticoduodenectomy

Objective:To recognize and to explore the early biliary complications after pancreaticoduodenectomy.Methods:All data of patients undergoing pancreaticoduodenectomy were collected from the Second Affiliated Hospital of Zhejiang University School of Medicine.The date is from January 1,2017 to August 1,2019.The data includes: pre-operative data: age,gender,total bilirubin concentration,adjuvant therapy,bile drainage,the width of biliary tract;surgical data: surgical approach,bile-enteric anastomosis,suture,biliary stent,vein resection,intraoperative blood transfusion,operation time;postoperative data: bile culture,drainage fluid culture,bilirubin,temperature,specimen pathology,and surgical complications.Early biliary complications were defined as biliary fistula,biliary stricture,cholangitis,and transient jaundice.A univariate analysis of all the related factors was performed to identify the factors that may be related to the occurrence of early biliary complications.Multivariate logistic regression analysis was performed to obtain independent risk factors related to biliary complications,P<0.05,means a statistical difference.Statistical analysis of data was processed using IBM SPSS 19.0.Results:A total of 315 patients were enrolled,and 48 patients had 51 early biliary complications,with an overall incidence of 15.2%.11(3.5%)were bile fistulas,8(2.5%)had biliary strictures,13(4.1%)had cholangitis,and 19(6.0%)had transient jaundice.8patients(73%)relied on continuous drainage for biliary fistula,and the remaining 3patients improved with interventional methods;8 patients with biliary stenosis re-operated in 2(25%),and the rest depended on conservative(n = 1,12.5 %)And interventional therapy(n = 5,67.5%);patients with cholangitis improved after conventional liver protection and anti-infective treatment;patients with transient jaundice can be relieved in a short time without special intervention.In multivariate analysis,benign diseases(P=0.039),non-absorbable suture(P=0.002),and intraoperative blood transfusion(P=0.006)were independent risk factors for early biliary complications.Conclusions:The incidence of early biliary complications after pancreaticoduodenectomy is high,which cannot be ignored.This article finds that early biliary complications after pancreaticoduodenectomy are easy to occur in benign diseases,using non-absorbable suture,and intraoperative blood transfusion.Elevated bilirubin in transient jaundice is characteristically different from biliary stenosis,which is helpful for clinical judgment.Overall,transient jaundice or cholangitis has a good prognosis,and biliary strictures or biliary fistulas may require intervention or surgery.Although the early postoperative biliary complications did not increase the patient's mortality,it prolonged the length of hospital stay and increased the medical costs,and we should focus on these possible risks.