Meta-analysis Of Risk Factors Of Biliary Fistula After Pancreaticoduodenectomy

Objective:At Present,Pancreaticoduodenectomy(PD)is the standard surgical treatment for benign and malignant tumors around the ampulla.It is complicated and there are many postoperative complications.Biliary fistula(BF)is a common anastomotic fistula after Pancreatic fistula.This article makes a meta-analysis of the risk factors of biliary fistula after Pancreaticoduodenectomy in order to provide a theoretical basis for reducing the occurrence of biliary fistula.Methods:The data about the risk factors of biliary fistula after Pancreaticoduodenectomy were extracted by searching the databases of PubMed,Embase,CNKI and Wan Fang,which were Published from January 2000 to January 2020,and the data were analyzed by RevMan5.3 software.Results:15 articles were included,A total of 6026 Patients and 266 with biliary fistula.the incidence of biliary fistula after PD was 4.41%.The results of Mata analysis showed that the incidence of postoperative biliary fistula in male Patients was significantly higher than that in female Patients(OR=1.42,95% CI:1.09-1.85,P=0.0010),The incidence of postoperative biliary fistula in cardiovascular disease group was significantly higher than that in non-cardiovascular disease group(OR=2.14,95%CI:1.27-3.59,P=0.004).The incidence of biliary fistula in preoperative total bilirubin ? 171mmol/L group was significantly higher than that in preoperative total bilirubin < 170mmol/L group(OR=0.56,95%CI:0.36-0.89,P=0.01)and bile duct diameter ? 1.5cm group was significantly higher than that in bile duct diameter ? 1.5cm group(OR=4.72,95%CI:2.38-9.36,P < 0.00001),the incidence of biliary fistula in Pancreatic fistula group was significantly higher than that in non-Pancreatic fistula group(OR=2.45,95%CI:1.74-3.45,P < 0.00001),intraoperative blood loss ? 1000 mL group was significantly higher than intraoperative blood loss < 1000mL(OR=0.39,95%CI:0.21-0.75,P=0.004)and postoperative hemoglobin < 90g/L was significantly higher than postoperative hemoglobin ? 90g/L(OR=3.63,95%CI:1.81-7.27,P=0.0003).The incidence of biliary fistula among Age,diabetes,preoperative albumin,preoperative hemoglobin,preoperative biliary drainage and malignant tumor were not significantly difference.Conclusion:Male,hypertension(or coronary heart disease),preoperative total bilirubin ? 171mmol/L,bile duct diameter ? 1.5cm,Pancreatic fistula,intraoperative blood loss ? 1000 mL and Postoperative hemoglobin < 90g/L were risk factors for biliary fistula after PD.