Risk Factors, Diagnosis And Treatment Of Complications In Laparoscopic Pancreatoduodenectomy

Objective:To explore the risk factors and management measures of perioperative complications in 200 cases of laparoscopic pancreatoduodenectomy.Methods:The clinical data of 200 patients who received laparoscopic pancreatoduodenectomy by "posterior approach,uncinate process priority,artery first" from January 2018 to March 2019 were analyzed retrospectively.We selected some clinical factors to analyze the risk factors of pancreatic leakage,abdominal infection,bleeding complications and summarized the management measures of postoperative complications.Results:The average total operation time was(260.23 ± 50.13)min,the sample cutting time was(86.56 ± 18.70)min,median intraoperative bleeding 50(50-100)ml,the average number of lymph node dissection was(19.2±7.4),the average postoperative hospital stay was(17.88 ± 9.91)days,18 patients with grade B pancreatic fistula(9.0%)and 2 patients with grade C pancreatic fistula(2.0%).Postoperative bleeding occurred in 16 cases(8.0%),including gastrointestinal anastomotic bleeding in 4 cases(2.0%),abdominal bleeding in 12 cases(6.0%).Gastric emptying was delayed in 5 cases(2.5%),bile leakage in 6 cases(3.0%),and death in 3 cases(1.5%).Pathological classification: IPMN: 5 cases,IPMN with related invasive cancer: 10 cases,Vater ampulla adenocarcinoma: 34 cases,tubular papilloma of bile duct with high-grade intraepithelial neoplasia: 1 case,chronic inflammation of bile duct: 4 cases,moderate dysplasia of bile duct epithelium: 1 case,adenocarcinoma of bile duct: 55 cases,2 cases of tubular adenoma of ampulla,3 cases of chronic pancreatitis,2 cases of interstitial tumor of duodenum,1 case of neuroendocrine tumor of duodenum,11 cases of adenocarcinoma of duodenum,2 cases of adenoma of duodenum,3 cases of heterotopia of duodenum and pancreas,50 cases of adenocarcinoma of pancreatic duct,4 cases of serous cystadenoma,4 cases of neuroendocrine tumor,5 cases of solid pseudopapilloma and 2 cases of mucinous cystadenoma.The risk factors of postoperative abdominal hemorrhage were the history of abdominal operation,pancreatic leakage and abdominal infection,and the risk factors of pancreatic leakage were postoperative hemorrhage and pancreatic duct diameter.Single factor analysis of abdominal infection was the occurrence of pancreatic leakage and bile leakage.At the same time,binary logistic regression was used to analyze the multiple factors of abdominal hemorrhage as abdominal infection,and the multiple factors of postoperative abdominal infection as bile leakage and pancreatic leakage.No clear risk factors were found in multivariate analysis of pancreatic leakage.Conclusions:1.Bile leakage and pancreatic leakage are independent risk factors of abdominal infection.The independent risk factors of abdominal bleeding were abdominal infection,abdominal operation history and pancreatic leakage.The independent risk factors of pancreatic leakage were abdominal infection,pancreatic duct diameter and postoperative hemorrhage.2.The principles of diagnosis and treatment of pancreatic leakage and abdominal infection need to ensure unobstructed drainage,pay attention to inflammatory indicators,or need to conduct ultrasound-guided drainage again.3.If the hemodynamics of postoperative hemorrhage is stable,endoscopy,intervention and conservative hemostasis can be given.If the hemodynamics is not stable,the second operation should be performed actively.