| Objective:To analyze the risk factors for grade B pancreatic fistula after pancreaticoduodenectomy.Methods:Retrospective analyses were conducted in the whole clinical data of patients who met the inclusion and exclusion criteria after PD from November,2014 to November,2017 in the First Hospital of China Medical University.And all the potential factors for grade B pancreatic fistula occuring in patients with biochemical leaks were analyzed with univariate and logistic regression multivariate model.Univariate analysis and measurement data were expressed as mean±standard deviation(x±s),using independent sample t test,counting data using?~2 test,and statistically significant factors using logistic regression analysis for multivariate analysis.Statistical analysis was performed using SPSS25.0 software,and the relative risk of each factor was calculated:OR,with P<0.05 as the difference.These statistically significant preoperative indicators which enabled the plotting of the receiver operation characteristic(ROC)curves were selected for plotting the ROC curves,calculating the area under the curve(AUC)and evaluating the forecast values.AUC>0.9 indicates a higher value,0.7-0.9 indicates a medium value,and 0.5-0.7 indicates a lower value.P<0.05 is considered statistically significant.With pertinence to indicators with the forecast values above the medium level,the maximum predictive performance of the critical value was determined by using the different cut-off values to calculate the Youden index and other indicators.Results:Of the 280 patients with PD,80 cases were eligible for inclusion and exclusion criteria.According to whether patients with biochemical leakage had grade B pancreatic fistula,they were divided into two groups,including 43 cases of biochemical leakage group and34 cases of B grade pancreatic fistula group.Univariate analysis showed preoperative general conditions include age,gender,body mass index,acute pancreatitis preoperatively,preoperative acute cholangitis,pancreatic duct diameter?3 mm,common bile duct diameter,preoperative correlation test index,pancreatic support tube drainage,operation time,postoperative abdominal or gastrointestinal bleeding,postoperative pathology,and post-operative 3/4 days of laboratory tests including hemoglobin,the platelet,?-glutamyltranspeptidase,alkaline phosphatase,aspartate aminotransferase,total bilirubin and prealbumin were not statistically significant.CT value of pancreatic body,pancreaticojejunostomy,the Alanine aminotransferase(ALT)on postoperative 3/4d were risk factors for grade B occuring in patients with biochemical leaks.Multivariate analysis showed CT value(95%CI=0.685,0.975)?end-to-side pancreaticojejunostomy(95%CI=1.409,56.909),and the Alanine aminotransferase on postoperative 3/4d(95%CI=1.000,1.016)were independent risk factors.Patients with anastomosed approach to pancreatic duct end-to-side anastomosis were less likely to develop grade B pancreatic fistula as well as those with the higher the CT value of the pancreatic body before surgery and the lower the ALT at 3/4 days after surgery.The AUC of CT value was 0.728.Using 39.54Hu as CT value,the sensitivity?specificity and Youden index were 72.97%?72.09%and 0.4507,with the highest performance prediction.Conclusion:Biochemical leakage is still clinically significant after PD,and if it is not properly handled or the disease itself evolves,grade B pancreatic fistula can occur.Therefore,it is necessary to attract the attention of clinicians.The analysis of CT value of pancreatic body for standardized judgment of pancreas texture can play a role in predicting the occurrence of postoperative grade B pancreatic fistula.In addition,selection of pancreatic duct end-to-side anastomosis prevent the progression of postoperative biochemical leakage to grade B pancreatic fistula.Perioperative liver protection may prevent the occurrence of grade B pancreatic fistula,but the mechanism of liver function on pancreatic fistula after PD remains to be further confirmed. |
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