A Comparative Analysis Of Abdominal Puncture And Drainage And Laparotomy In The Treatment Of C-grade Postoperative Pancreatic Fistula With Severe Abdominal Infection

Objective: To analyze the clinical manifestation,diagnosis,treatment and curative effect of postoperative pancreatic fistula with severe abdominal infection,and to guide the early detection,diagnosis and treatment of postoperative pancreatic fistula with severe abdominal infection.Methods: The clinical data of 35 cases of C-grade postoperative pancreatic fistula with severe abdominal infection in hepatobiliary surgery of the Second Affiliated Hospital of Chongqing Medical University from January 2010 to March 2020 were analyzed retrospectively.The initial diagnosis was based on the patient's past medical history(operation history)and clinical manifestations.The final diagnosis was based on the blood chart analysis,ascites amylase,drainage amylase and other laboratory examination results,abdominal examination results According to the results of imaging examination such as color Doppler ultrasonography and CT,different treatment methods are selected according to different conditions of patients.Results: In this group,35 patients 26 males(74%)and 9 females(26%)with grade C pancreatic fistula and severe abdominal infection were treated.All pancreatic fistulas were classified as grade C,and severe abdominal infection related to pancreatic fistulas occurred.Among them,20 patients underwent abdominal puncture and drainage(57%),15 patients underwent abdominal cleaning and drainage(43%).The average length of stay in the second operation group was 15.50 ± 2.63 days,which was significantly lower than that in the open abdominal cavity group 34.60 ± 5.65 days(P = 0.002);the average length of incision in the abdominal cavity group was 2.50 ± 0.22 cm,it was significantly shorter than that in the open abdominal cavity cleaning + tube drainage group 20.13 ± 0.81 cm(P = 0.000);The average operation time of the group was 36.50 ± 3.57 minutes,which was significantly shorter than that of the group of abdominal cavity cleaning and tube drainage,218.00 ± 15.25 minutes(P = 0.000);The mean blood loss in the group of abdominal puncture and drainage was 13.45 ± 0.88 ml,which was significantly less than that in the group of abdominal cleaning and drainage 453.33 ± 38.87 ml(P = 0.000).Conclusion: The main cause of death after pancreatic surgery is grade C pancreatic fistula combined with abdominal infection.The early diagnosis rate of pancreatic fistula can be improved to a certain extent by combining the clinical history(operation history)and various auxiliary examinations.At the same time,active intervention measures should be taken in the early stage.If the conditions permit,the first choice is abdominal puncture and drainage.At the same time,the perioperative management and support treatment should be strengthened to reduce complications and shorten the length of stay.