Analysis Of Risk Factors Of Late Bleeding After Laparoscopic Pancreatoduodenectomy(Single-Center)

Objective To analyze the risk factors of late bleeding after laparoscopic pancreatoduodenectomy(LPD)and further improve clinicians' correct understanding of post-pancreaticoduodenectomy hemorrhage(PPH).The goal is to prevent PPH scientifically and efficiently,reduce PPH events greatly,and thus improve surgical quality.Method Retrieve HiS electronic medical record system of the second hospital of Lanzhou University,and retrospectively collect the medical records of 128 LPD patients in the minimally invasive surgery department of our hospital from August2013 to December 2019.All of the patients were divided into PPH group and non-PPH group according to whether postoperative bleeding or not.There were 25patients(19.5%,male: female =16:9)in the PPH group,and the average age was58.76±9.58 years.While in the non-PPH group there were 103 patients(80.5%,male:female =62:41),and the average age was 55.01 ± 10.80 years.There were 45patients(35.2%)who received biliary drainage before surgery.Among whom 20.0%(9/45)were treated with percutaneous transhepatic cholangial drainage(PTCD)and80.0%(36/45)were endoscopic nasobiliary drainage(ENBD).Of these patients,15 with chronic diabetes,17 with chronic hypertension and 18 with operation history of the abdomen or pelvis.Statistical analyses were performed with SPSS 25.0.A chi-square test,rank-sum test or Student t-test was selected to compare and analyze the clinical data of 15 different classifications of patients in the two groups.The clinical factors that were collected and examined included gender,age,body mass index(BMI),chronic hypertension and diabetes,preoperative levels of albumin and hemoglobin,the count of platelets,preoperative serum bilirubin levels and biliary drainage processing,blood loss and transfusion therapy during operation,treatment of postoperative analgesia,postoperative pancreatic fistula(POPF)and abdominal infection complications.To investigate the correlations between these indicators and PPH.Multivariate logistic regression analyses were carried out to determine independent predictors of PPH in LPD patients and analyses them in detail.It is worthnoting that the only significant factors were subjected to multivariate analysis.Results No difference could be shown between PPH group and non-PPH group(p >0.05)in gender,age,BMI,chronic hypertension and diabetes,preoperative levels of albumin and hemoglobin,the count of platelets,blood loss during operation and abdominal infection complications.While the differences in preoperative serum bilirubin levels and biliary drainage processing,transfusion therapy during operation,treatment of postoperative analgesia and POPF between the two groups were statistically significant(p<0.05).In multivariate analysis,preoperative biliary drainage processing(OR=0.057,95%CI:0.011~0.295),transfusion therapy during operation(OR=0.244,95%CI:0.075~0.794)and treatment of postoperative analgesia(OR=0.183,95%CI:0.058~0.578)were statistically significant in the PPH group and the non-PPH group,which were protective factors of PPH after LPD(p<0.05).While preoperative high levels of serum bilirubin(OR=1.008,95%CI:1.003~1.014)were independent risk factors of them.Conclusion Preoperative serum bilirubin levels and biliary drainage processing,treatment of postoperative analgesia,transfusion therapy during operation,and POPF were linked to PPH.Also,preoperative biliary drainage processing(OR=0.057),transfusion therapy during the operation(OR=0.244)and treatment of postoperative analgesia(OR=0.183)were protective factors for PPH after LPD.While preoperative high levels of serum bilirubin(OR=1.008)were independent risk factors of them.Whether the treatment of POPF is timely and the strategy is appropriate can directly affect the incidence of PPH.When POPF combined with abdominal infection complications,PPH events may be increased.