| Objective:Postoperative pancreatic fistula is a common and serious complication after laparoscopic pancreaticoduodenectomy,which can often lead to complications such as secondary abdominal infection and abdominal hemorrhage.This study retrospectively analyzed clinical data of 200 patients that admitted to our center and underwent laparoscopic pancreaticoduodenectomy,and analyzed the general data,preoperative examination data,intraoperative,postoperative and pathological data of the patients,and explored the influencing factors of clinical pancreatic fistula after LPD.To provide some means and ideas for pancreatic surgeons to prevent pancreatic fistula after LPD.Methods:Collect the factors that may affect the postoperative clinical pancreatic fistula after LPD:General patient data,preoperative examination data,intraoperative data,postoperative and pathological data,etc.The clinical data collected from 200 patients and whether they were complicated by clinical pancreatic fistula were assigned to SPSS 26.0 for univariate analysis.The meaningful indicators in the analysis results can be determined as the influencing factors related to clinical pancreatic fistula after LPD.In order to eliminate the effect of confounding factors and further clarify the impact of each single factor on the clinical pancreatic fistula after LPD,the influencing factors related to the clinical pancreatic fistula after LPD were included in the binary logistic regression analysis.The factor analysis showed that the independent influencing factors of clinical pancreatic fistula after LPD were obtained.Results:There were 26 clinically relevant pancreatic fistulas(Grade B/C)in 200 LPD postoperative patients,with an incidence rate of 13%.Through single factor analysis:Age,gender,history of hypertension,history of diabetes,history of cardiovascular and cerebrovascular diseases,history of hepatitis,history of smoking,history of drinking,history of upper abdominal surgery,whether there is a history of preoperative yellowing history,preoperative CA125 and CA199,preoperative total bilirubin,preoperative direct bilirubin,preoperative AST,preoperative ALT,preoperative γ-GT,intraoperative blood loss,intraoperative total fluid infusion,intraoperative infusion Red blood cells,ASA grade,white blood cells on the third postoperative day,albumin on the third postoperative day,tumor benign and malignant,tumor diameter,etc.These factors were not associated with clinical pancreatic fistula after LPD(P>0.05).Factors such as BMI,preoperative albumin,operation time,main pancreatic duct diameter,pancreatic texture,ASA grade,tumor location and other factors were related influencing factors of clinical pancreatic fistula after LPD(P<0.05).Through multi-factor analysis:BMI(P<0.001),main pancreatic duct diameter(P=0.049),pancreatic texture(P=0.012),and preoperative albumin(P=0.001)are independent influencing factors of clinical pancreatic fistula after LPD.Conclusion:1.Factors such as BMI,preoperative albumin,operation time,main pancreatic duct diameter,pancreatic texture,ASA grade,tumor location and Theses factors may be related to the occurrence of clinical pancreatic fistula after LPD.2.Large BMI,soft pancreas,narrow pancreatic duct diameter,and low preoperative albumin levels are independent risk factors for clinical pancreatic fistula after LPD.When these risk factors exist,clinical pancreatic fistula is more likely to occur after surgery.3.Clinical pancreatic fistula after LPD has a greater impact on the prognosis.The risk of abdominal infection is increased,postoperative bleeding,secondary operations,and mortality are higher,the time of abdominal drainage tube removal is prolonged,and the probability of gastrointestinal emptying disorder is higher,and it is obvious Increase postoperative hospital stay and hospital costs.4.Preoperative selection of patients with small BMI,pancreatic duct dilatation,hard pancreas,and normal albumin levels for LPD surgery may reduce the probability of postoperative clinical pancreatic fistula. |
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