Risk Factors Analysis And Risk Prediction Of Pancreatic Fistula After Pancreaticoduodenectomy

Objective:Pancreaticoduodenectomy(PD)is the preferred method for the treatment of various benign and malignant diseases in the pancreatic ampullary abdomen.With the progress of clinical treatment technology,postoperative complications of PD have been relatively reduced,but one of the postoperative complications,pancreatic fistula(PF),is still the most common postoperative complication of PD.In this paper,the risk factors of pancreatic fistula after pancreaticoduodenectomy were discussed based on the clinical data of 138 PD patients in the first hospital of Shan Xi medical university,so as to provide reference for the improvement and reduction of complications of pancreatic fistula after PD surgery.Methods:The clinical data of 138 PD patients admitted to the first hospital of shanxi medical university for general surgery from February 2013 to December 2019 were selected as the subjects of this study for retrospective analysis.According to the pancreatic fistula diagnostic criteria issued by ISGPS,the subjects were divided into the pancreatic fistula group(grade B/C pancreatic fistula)and the non-pancreatic fistula group.To the patients themselves and perioperative 13 related factors including(age,gender,diabetes mellitus,hypertension,preoperative albumin,total bilirubin,preoperative,preoperative anemia,merger,operation time,intraoperative blood loss,the pancreatic anastomosis way,pancreas,pancreatic duct diameter texture,postoperative pathological results)carrying out statistical method of single factor,the result of the single factor analysis meaningfulfactors(P < 0.05)PD multiariable logistic regression analysis the influence factors of postoperative pancreatic fistula and pancreatic fistula risk prediction model is established.Results:Among 138 patients with PD,50(36.2%)had postoperative complications,26(18.8%)had pancreatic fistula(grade B,grade C),among which 24(17.4%)had grade B pancreatic fistula,2(1.4%)had grade C pancreatic fistula,and 112(81.2%)had no pancreatic fistula.Among the 138 patients,6(4.3%)had abdominal bleeding,32(23.2%)had gastrointestinal bleeding,5(3.6%)had biliary fistula,42(30.4%)had abdominal or pulmonary infection,and 12(8.7%)had pancreatic fistula with other complications.There were 3 patients(2.2%)with secondary surgery and 2 patients(1.4%)with postoperative death.According to single factor analysis,the influencing factors of postoperative pancreatic fistula included preoperative TBIL value,pancreatic duct diameter and pancreatic texture(P<0.05).Other factors included gender,age,history of diabetes,history of hypertension,anemia,preoperative Alb,operative time,anastomosis,intraoperative blood loss,and lesion site.According to multivariate logistic regression analysis,preoperative TBIL>171umol/L(OR=5.376,95%ci: 1.569?18.422,P=0.007),pancreatic duct diameter ?3mm(OR=6.078,95%ci: 1.548?23.865,P= 0.010)and pancreatic soft texture(OR=15.755,95%ci: 5.200?47.735,P <0.001)were independent risk factors for pancreatic fistula after PD.Based on this,the prediction model of pancreatic fistula after PD was established.In the single-factor prediction model,the prediction of pancreatic texture index was the strongest(AUC=0.803),followed by the preoperative TBIL value(AUC=0.630),and the prediction of pancreatic duct diameter was relatively low(AUC=0.624).After the combination of the three,the predictive efficiency of pancreatic fistula was up to 0.889.Conclusion:Preoperative TBIL>171umol/L,soft pancreas and small pancreatic duct indicated ahigh risk of pancreatic fistula after pancreaticoduodenectomy.For patients with excessive TBIL level,preoperative yellow reduction measures(drugs,PTCD,ENBD,etc.)can be used to reduce TBIL to improve perioperative safety and reduce the incidence of postoperative complications.The soft pancreatic texture and small pancreatic duct can be avoided by improving the operative method and the pancreatic anastomosis method and placing the stent in the pancreatic duct.Pancreatic texture,preoperative TBIL and pancreatic duct diameter had certain predictors on POPF.After the combination of the three factors,the prediction efficiency of POPF was the strongest.