Analysis Of The Incidence And Related Factors Of Pancreatic Fistula After Pancreaticoduodenectomy By Chen′s Pancreaticojejunostomy Technique

Objective:To evaluate the curative effect of Chen′s pancreaticojejunostomy technique on pancreaticoduodenectomy(PD),analyzing the risk factors of postoperative pancreatic fistula(POPF)based on our clinical data.Methods:63 patients with PD in Peking University Shenzhen Hospital were retrospectively collected from January 2017 to September 2020,among which 29cases were performed with Chen′s pancreaticojejunostomy technique and 34 cases were traditional mucosa-to-mucosa pancreaticojejunostomy.The preoperative,perioperative and short-term follow-up data of postoperation were analyzed to compare the indexes between Chen’s pancreaticojejunostomy technique and traditional pancreaticojejunostomy,besides,the risk factors for pancreatic fistula were investigated based on the clinical data.A total of three experienced chief physicians participated in the operation,and the perioperative period was performed according to the routine postoperative pancreatic procedures.Results:There were more diabetic patients in Chen’s group,and no significant difference of other basic clinical characteristics was found in these two groups(P>0.05).According to the comparison result,The average operation time in Chen’s group was obvious shorter than other group(368.1±108.8 min vs 427.4±121.1 min,P=0.047).Significant differences of two groups were represented in postoperative complications of Clavien-Dindo grade≥2(41.4%vs 67.6%P=0.037),days of pancreaticojejunal drainage tube extubation(15.3±8.7 vs 20.6±9.5 P=0.026),rate of grade B/C pancreatic fistula(10.3%vs 32.3%P=0.036)and incidence of postoperative abdominal infection(10.3%vs 32.3%P=0.036).The results of univariate analysis of POPF showed that the BMI(P=0.013),pancreatic texture(P=0.025),and lymph node metastasis(P=0.022)were closely associated with POPF.Then the results of multivariate analysis demonstrated that BMI>21kg/m~2(OR,7.979;P=0.022),soft pancreas(OR,5.249;P=0.025),and intraoperative bleeding>750 m L(OR,10.722;P=0.006)were the independent risk factors for pancreatic fistula.Conclusion:Compared with the approach of traditional pancreaticojejunal mucosa to mucosa,the longitudinal"U"-shaped suture for the pancreas of Chen’s pancreaticojejunostomy has better applicability in PD of small pancreatic duct,with a lower incidence of severe pancreatic fistula,which can be applied as a reliable alternative for pancreaticojejunostomy.Of note,BMI>21 kg/m~2,soft pancreas,and intraoperative bleeding>750 ml are the independent prognostic factors for POPF.In order to reduce the incidence of postoperative complications,physicians should flexibly and individually make the strategy of anastomosis according to the patient’s preoperative intraoperative conditions.