Analysis Of Influencing Factors Of Delayed Gastric Emptying After Pancreaticoduodenectomy

Objective:Use patient perioperative data to conduct retrospective research to analyze and explore the related factors of DGE complications in the patients who is performed the pancreaticoduodenectomy,and provide evidence for prevention and treatment to decrease the occurrence of postoperative DGE and shorten the postoperative hospital stay.Methods:This study analyzed the clinical data of patients who is performed the pancreaticoduodenectomy,in Shandong Provincial Hospital through the case-control method(2018.1.1-2018.12.31).There were 247 cases in total,and 2 postoperative death cases and 2 cases with incomplete data were excluded.A total of 243 cases were included in the analysis study.Consult relevant information,formulate comprehensive diagnostic criteria according to China’s Qin Xinyu standard and ISGPS B-level standards and above standards,and divide the cases into DGE group(43 cases)and non-DGE group(200 cases),and compare and analyze the gender,gender,and gender of the two groups of cases.Age,whether there is a history of hypertension and Coronary heart disease,whether there is a history of diabetes,whether there is a history of surgery about the abdomen,the main clinical symptoms of the onset,the duration of jaundice,preoperative hemoglobin,preoperative fasting blood glucose,preoperative albumin,preoperative Total bilirubin,preoperative alanine aminotransferase,preoperative aspartate aminotransferase,preoperative CEA,preoperative CA199,preoperative PT,whether preoperative yellowing,open surgery or laparoscopic surgery,duration of surgery.bleeding,during surgery,surgery Medium blood transfusion,tumor size,tumor location,whether there are postoperative complications(pancreatic fistula,biliary fistula,gastrointestinal bleeding,abdominal hemorrhage,gastric emptying disorder,abdominal infection,anastomotic fistula,abdominal abscess),postoperative hospital stay,etc.The data was analyzed and researched,and statistical methods such as t-test and chi-square test were used to compare and analyze the data.Multivariate Logistic regression analysis was used to explore and analyze the influencing factors of DGE after PD.Results:There were 43 cases of 243 PD patients with DGE after operation,the incidence rate was 17.6%.By comparing the clinical data of the two groups of patients and using the χ2 test,the preoperative fasting blood glucose levels and preoperative albumin levels in the preoperative data were obtained(ALB)The difference was statistically significant(P<0.05);the patient’s gender,age,history of hypertension,history of coronary heart disease,history of diabetes,history of abdominal surgery,duration of jaundice,preoperative hemoglobin,surgery Pre-total bilirubin,pre-operative alanine aminotransferase,pre-operative aspartate aminotransferase,pre-operative CEA,pre-operative CA199,pre-operative PT,preoperative reduction of jaundice had no significant difference in the occurrence of postoperative delayed gastric emptying(P>0.05);The difference in intraoperative blood loss was statistically significant(P<0.05).There was no significant difference in the incidence of delayed gastric emptying after operation due to factors such as operation method,intraoperative blood transfusion,and operation duration(h)(P>0.05)In the postoperative data,The difference between postoperative pancreatic fistula and postoperative abdominal infection was statistically significant(P<0.05),while the difference between postoperative biliary fistula and postoperative bleeding was statistically insignificant(P>0.05);patients Preoperative fasting blood glucose,preoperative albumin,and postoperative abdominal cavity infection are independent risk factors for postoperative DGE.The risk of delayed gastric emptying in person with preoperative fasting blood glucose ≥6.0 mmol/L was significantly higher than that of patients with preoperative fasting blood glucose less than 6 mmol/L,and it was statistically significant(OR=2.193,95%CI 1.045-4.604,P<0.05);The risk of DGE in patients with preoperative albumin<30g/L was significantly higher than the control group,it was statistically significant(OR=4.350,95%CI:1.306-14.484.P<0.05);The risk of DGE in person with posterior abdominal cavity infection was significantly increased,it was statistically significant(OR=4.480,95%CI 1.869-10.735,P<0.01).Intraoperative blood loss(≥500ml)and pancreatic fistula were independent risk factors for delayed gastric emptying(P>0.05).Conclusion:Preoperative fasting blood glucose,preoperative albumin level,intraoperative blood loss,postoperative abdominal infection and postoperative pancreatic fistula were all related to the occurrence of postoperative DGE.Among them,preoperative ALB<30g/L,preoperative fasting blood glucose≥6.0mmol/L,postoperative abdominal infection are independent risk factors for delayed gastric emptying;intraoperative blood loss and postoperative pancreatic fistula are not independent risk factor.