| Objective: Random the Pancreatic duct-jejunum mucosa of the pancreatic duct jejunum mucosa end side anastomosis and Pancreatic-duct hanging and end-to-side continuous pancreaticojejunal anastomosis of pancreatic anastomosis in Pancreaticod-uodenectomy(PD),comparative analysis of two groups of patients with early postoperative complications,discusses suspension type continuous suture pancreatic duct jejunum end side of the clinical application value of anastomosis in PD.Then,according to the preoperative level of total bilirubin(TBIL)and serum albumin(ALB)levels are divided into two subgroups in group and the comparative analysis,evaluation of the effectiveness and safety operation..Methods:A retrospective study was conducted to collect the patients who underwent from August 2015 to August 2018,the pancreaticoduodenectomy was conducted in the Second Ward of Hepatobiliary and Pancreatic Surgery of XX.A total of 206 patients were included.According to different surgical methods,these patients were selected as Hang group and Classical group.A total of 119 patients in Hang group were selected.Both groups used suspended jejunal end-to-side continuous suture anastomosis for enteropancreatic anastomosis.A total of 87 patients in the Classical group received the end-to-side anastomosis of pancreatic duct-jejunum mucosa to mucosa.There were two subgroups for deal with the two factors for which opinions were not yet unified:(1)bilirubin subgroup: it was set as high bilirubin subgroup,TBIL?171?mol/L);Low Bilirubin subgroup,TBIL?171?mol/L,according to the severity of jaundice.High Bilirubin subgroup were 43 cases in the Hang group and 23 cases in the Classical group.Low Bilirubin subgroup were 79 cases in the Hang group and 64 cases in the Classical group.(2)Albumin subgroup: according to whether the patients were complicated with hypoproteinemia before operation,they were divided into High Albumin subgroup(ALB?35g/L)and Low Albumin subgroup(ALB?35g/L).Low Albumin subgroup were 34 cases in the Hang subgroup,28 cases in the Classical group.High Albumin subgroup were 85 cases in the,and 59 cases in the Classical group.Preoperative data(gender,age,BMI,HGB,ALB,TBIL,comorbidities and history of abdominal surgery)and intraoperativedata(operation time,intraoperative blood loss,number of blood transfusions,pancreatic texture,pancreatic duct diameter and other special circumstances)of patients in Hang group and Classical group and their corresponding subgroups,respectively.Postoperative complications data(total complications,perioperative death,pancreatic fistula(PF),biochemical leakage,postoperative bleeding(PPH),delayed gastric emptying(DGE),biliary fistula,chyle leakage,abdominal infection and incision infection)and pathological data,postoperative recovery(postoperative abdominal drainage tube indwelling time,total hospitalization costs,hospital stay and number of patients undergoing reoperation were compared in statistical analysis.Results:1.There was no significant difference in preoperative data between Hang group and Classical group(P?0.05).(1)Hang group:In the preoperative data of the Low Bilirubin subgroup and High Bilirubin subgroup,only TBIL was statistically significant(P?0.05),and TBIL was 47.89±45.48(?)mol/L and 260.99±60.59(?)mol/L,respectively.There was no significant difference in other preoperative data(P?0.05).Differences can be compared between the two subgroups.In the preoperative data of High Albumin subgroup and Low Albumin subgroup in the Hang group,only ALB had statistical significance(P?0.05),and ALB was 39.25±2.45g/L and31.57±2.44g/L,respectively.There was no significant difference in other preoperative data(P?0.05).Differences can be compared between the two subgroups.(2)Classical group:In the preoperative data of Low Bilirubin subgroup and High Bilirubin subgroup,only the difference of TBIL was statistically significant(P?0.05).TBIL was28.5(21.30 ?54.10)?mol/L and 260.3(182.3 ? 318.6)?mol/L,respectively.There was no significant difference in other preoperative data(P?0.05).Differences can be compared between the two subgroups.In the preoperative data of patients in High Albumin subgroup and Low Albumin subgroup,only ALB had statistical significance(P?0.05),and ALB was39.16±1.86g/L and 31.97±2.76g/L,respectively.There was no significant difference in other preoperative data(P?0.05).Differences can be compared between the two subgroups.2.The operation time of Hang group and Classical group was 356.76 ±71.80 min and 377.99±68.52 min,respectively.The operation time of Hang group was significantly lower than that of Classical group,and the difference had statistical significance(P?0.05).There was no significant difference in the remaining intraoperative data(P?0.05).Pathological datashowed 30 cases of benign lesions(14.6%)and 176 cases of malignant lesions(85.4%),with no statistical difference between the two groups(P?0.05).(1)Hang group:In the High Bilirubin subgroup,12 cases of blood transfusion during operation were significantly higher than that in the Low Bilirubin subgroup(27.9% vs 7.9%),and the difference had statistical significance(P?0.05).The intraoperative blood loss in High Bilirubin subgroup was more than that in Low Bilirubin subgroup [350(300?400)ml vs 350(280?397.5)ml],and the difference had statistical significance(P?0.05).There was no significant difference between the two subgroups(P?0.05).There was no significant difference in the intraoperative data between the High Albumin subgroup and Low Albumin subgroup(P?0.05).(2)Classical group:The intraoperative blood loss in High Bilirubin subgroup was more than that in Low Bilirubin subgroup[345(280?380)ml vs 380(380?430)ml],and the difference had statistical significance(P?0.05).There was no significant difference between the two subgroups(P>0.05).There was no significant difference in the intraoperative data(operation time,intraoperative blood loss,number of blood transfusions,pancreatic texture,pancreatic duct diameter and other special circumstances)between High Albumin subgroup and Low Albumin subgroup(P>0.05).3.Of the 206 patients,81(39.3%)had postoperative complications and 1(0.5%)had perioperative death.The number of patients with pancreatic fistula(grade B+C)in the Classical group was significantly higher than that in the Hang group(19.5% vs 8.4%),and the difference had statistical significance(P<0.05).Among them,there were 15 cases(17.2%)with grade B pancreatic fistula and 2 cases(2.3%)with grade C pancreatic fistula in the Classical group.There were 9 cases(7.6%)of pancreatic fistula and 1 case(0.8%)of grade C pancreatic fistula in the Hang group.There was significant difference in the incidence of grade B pancreatic fistula between the two groups(P<0.05).There was no significant difference in the occurrence of other postoperative complications(P>0.05).(1)Hang group:There were no significant differences in postoperative complications between Low Bilirubin subgroup and High Bilirubin subgroup(P?0.05).There were no significant differences in postoperative complications between High Albumin subgroup and Low Albumin subgroup(P?0.05).(2)Classical group : There were no significant differences in postoperative complicationsbetween Low Bilirubin subgroup and High Bilirubin subgroup(P?0.05).Pancreatic fistula incidence in Low Albumin subgroup and High Albumin subgroup was 32.1% and 13.6%,respectively,and the difference was statistically significant(P?0.05).There was no significant difference in the data of other postoperative complications(P?0.05).4.The indwelling time of peritoneal drainage tube in Hang group was significantly lower than that in Classical group,and the difference had statistical significance(P?0.05).There was no significant difference in other postoperative recovery data(P?0.05).(1)Hang group:There were no significant differences in postoperative recovery data between Low Bilirubin subgroup and High Bilirubin subgroup(P?0.05).There were no significant differences in postoperative recovery data between High Albumin subgroup and Low Albumin subgroup(P?0.05).(2)Classical group : There were no significant differences in postoperative recovery data between Low Bilirubin subgroup and High Bilirubin subgroup(P?0.05).There were no significant differences in postoperative recovery data between High Albumin subgroup and Low Albumin subgroup(P?0.05).Conclusion: 1.Pancreatic-duct hanging and end-to-side continuous pancreaticojejunal anastomosis could significantly shorten the operation time,effectively reduce the incidence of POPF,which is a simple,safe,effective and wide application method.2.High preoperative TBIL(TBIL? 171 mol/L)is a risk factor for increased intraoperative blood loss in PD. |
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