Comparative Study Of Perioperative Effects Of Different Pancreaticojejunostomy Methods On Pancreaticoduodenectomy

Objective: By comparing the efficacy and safety of duct to mucosa anastomosis,Peng’s anastomosis and Chen’s U-Suture Technique when open pancreaticoduodenectomy is needed in patients with pancreatic head cancer and periampullary cancer,To explore the optimal way of pancreaticojejunostomy and provide reference for clinical decision-making.Methods: 1.Retrospective analysis was adopted in this study.A total of 153 patients with pancreatic head carcinoma and periampullary carcinoma were enrolled in this study.All patients underwent pancreaticoduodenectomy.According to the different methods of pancreaticojejunostomy,the patients were divided into duct to mucosa anastomosis group,Peng’s anastomosis group and Chen’s U-Suture Technique group.Duct to mucosa anastomosis was used in 60 patients,Peng’s anastomosis in 63 patients,and Chen’s U-Suture Technique in 30 patients.2.Outcome indicators included the overall incidence of postoperative complications,including pancreatic fistula,biliary fistula,postoperative bleeding,abdominal infection,incision infection,and delayed gastric empties;Duration of operation,diameter of pancreatic duct,texture of pancreas,intraoperative blood loss,length of postoperative hospital stay.Statistical processing SPSS26.0 statistical software was used for statistical analysis of experimental data.Quantitative data were expressed as mean ±standard deviation.The classification variables were statistically described by frequency(F)or constituent ratio(%).The quantitative data of the three groups were compared using variance test,and the least significant difference test(LSD test)was used for pair comparison among the three quantitative data groups.The significance test level α=0.05,and P < 0.05 was considered statistically significant.Difference of three groups of constituent ratio test using chi-square(chi square),three sets of comparison test of significance level of α=0.05,P < 0.05 for the difference was statistically significant,such as three groups than differences statistically significant,comparing two in the group,two more in the group of three groups of form than a Bonferroni correction,two comparison test of significance level for the Bonferroni correction is α = 0.0167,P < 0.0167 for the difference was statistically significant.Results: 1,the duct to mucosa anastomosis group have 17 patients with pancreatic fistula after the surgery,the incidence was 28.3%,Peng’s anastomosis group have seven cases of pancreatic fistula,rate of 11.1%,Chen’s U-Suture Technique group have three cases of pancreatic fistula,the incidence was 10%,the comparison group(P=0.021),difference was statistically significant,Peng’s anastomosis group is compared with the duct to mucosa anastomosis group(P=0.016),the difference was statistically significant.2,Duct to mucosa anastomosis group have 10 patients with biliary fistula,postoperative incidence was 16.7%,Peng’s anastomosis group has two patients with biliary fistula,rate of 3.2%,Chen’s U-Suture Technique group have 2patients with biliary fistula,the incidence was 6.7%(P=.03)difference was statistically significant,Peng’s anastomosis group is compared with the duct to mucosa anastomosis group(P=0.012)the difference was statistically significant.3,Duct to mucosa anastomosis group’s overall complication rate was 66.7%,Peng’s anastomosis group was 42.9%,Chen’s U-Suture Technique group overall complication rate was 43.3%,and the comparison group P value is 0.017,statistically significant differences,Peng’s anastomosis group is compared with the duct to mucosa anastomosis group(P=0.008),the difference was statistically significant.4,Duct to mucosa anastomosis group’s average operation time was 370.72±104.58(min),Peng’s anastomosis group’s average operation time was 366.67±73.86(min),Chen’s U-Suture Technique group’s average operation time was 295.00±88.00(min),between the three groups of P value is 0.000,statistically significant differences,Duct to mucosa anastomosis group compare with Chen’s U-Suture Technique group the P value is 0.000,which was statistically significant,Peng’s anastomosis group with Chen’s U-Suture Technique compare the P value is 0.000,which was statistically significant.5,Duct to mucosa anastomosis group’s mean intraoperative blood loss was 649.19±174.79(ml),Peng’s anastomosis group intraoperative blood loss was 463.65±181.13(ml),Chen’s U-Suture Technique group intraoperative blood loss was 385.67±136.53(ml),between the three groups(P=0.000),whcih is statistically significant differences,three groups in both two more P values is0.000,the difference was statistically significant.6,Duct to mucosa anastomosis group’s of the average postoperative hospital stay was 17.85±9.30(day),Peng’s anastomosis groups of the average postoperative hospital stay was17.37±8.90(day),Chen’s U-Suture Technique group average postoperative hospital stay was 13.70±5.10(day),P value is 0.076 between the three groups,there was no statistically significant difference,the duct to mucosa anastomosis group and Chen’s U-Suture Technique group compare and the P=0.03,the difference was statistically significant.7.There was no statistical significance in the incidence of postoperative abdominal hemorrhage,postoperative abdominal infection,postoperative incision infection and delayed gastric emptying among the three groups.Conclusion: When open pancreaticoduodenectomy is needed for patients with pancreatic head cancer and periampullary cancer,pancreaticojejunostomy with Peng’s anastomosis can effectively reduce the incidence of postoperative pancreatic fistula,biliary fistula and overall complications.The average operation time,intraoperative blood loss and postoperative hospitalization time can be effectively reduced by using Chen’s U-Suture Technique.