Effect Of Different Placement Of Pancreatic Duct Supporting Duct On Pancreatic Fistula After Whipple

Objective: After pancreaticoduodenectomy(PD),the clinical data of different pancreatic duct supporting tube placement methods were compared to study their effects on postoperative pancreatic fistula(POPF)and hospitalization time and cost,so as to provide clinicians with appropriate pancreatic duct support tube placement methods to reduce the occurrence of POPF and other complications,reduce hospitalization costs and shorten hospitalization time.Methods: Through retrospective analysis,the clinical data of patients with feasible PD treated in the affiliated Hospital of Inner Mongolia Medical University from January 2016 to January 2021 were collected.According to the inclusion and exclusion criteria,the collected data were divided into three groups according to the drainage mode of supporting tube,namely,internal drainage group(group A),external drainage group(group B)and unplaced group(group C).There were 70 cases in group A,51 cases in group B and 21 cases in group C.The related indexes of patients before operation were analyzed and compared,including sex,age,hypertension,diabetes,heart disease,history of operation,preoperative,TBIL,DBIL,IDBIL,ALB,hemoglobin and so on.The related indexes during operation were pancreatic texture,pancreatic duct diameter,pathological results,operation time,intraoperative blood loss,pancreatic duct supporting tube placement,pancreaticoenterostomy,postoperative pancreatic fistula,biliary fistula,anastomotic leakage,bleeding,incision infection,pulmonary complications,disturbance of postoperative gastric emptying,secondary operation,perioperative death,hospitalization time,hospitalization cost and so on.According to the specific analysis of the related factors of pancreatic fistula,and using the FRS system score grouping to further study the influence of internal and external drainage on pancreatic fistula.Results: Retrospective analysis of the data of patients undergoing PD showed that there were 81 males and 61 females,all aged from 18 to 78 years old,with an average age of 58.5 years,70 patients(49.3%)in group A,5 patients died.51 patients(35.9%)in group B,no death,and 21 patients(14.8%)in group C,one case died(RPD).Among the three groups,there were 29 cases of pancreatic fistula(group A: 14 cases;group B: 4 cases;group C: 11 cases),biliary fistula(n = 6),postoperative bleeding(n= 10),anastomotic fistula(n = 4),incision infection(n = 6),pulmonary complications(n = 8),disturbance of gastric emptying(n = 6),secondary operation(n = 13)and perioperative death(n = 13).There was a significant difference in POPF between group C and group A+B(p<0.05).The proportion of pancreatic fistula in group C was significantly higher than that in group A+B(14.88%).There was no significant difference in other complications(p>0.05).All patients were scored by FRS system and divided into four risk groups.There was no significant difference in the incidence of pancreatic fistula between internal drainage and external drainage in non-risk and low-risk groups(p>0.05).However,the incidence of internal drainage pancreatic fistula was significantly higher than that of external drainage pancreatic fistula in high risk population(p<0.05).Univariate results showed that pancreatic texture and pancreatic duct diameter were correlated with POPF(p<0.05),while multivariate analysis showed that pancreatic texture(OR=0.218,p=0.001)and pancreatic duct diameter ≥ 3mm(OR=0.302,p=0.021)were protective factors for POPF,that is,soft pancreas and pancreatic duct diameter<3mm were risk factors for postoperative pancreatic fistula.The hospitalization time and cost in group A were significantly lower than those in group B(p<0.05).Conclusion: After PD,the placement of supporting tube in the main pancreatic duct can effectively reduce the occurrence of POPF and is beneficial to the recovery of patients after operation.In the non-risk population and low-and medium-risk population,the choice of internal drainage can reduce the cost of hospitalization and reduce the length of stay.External drainage can effectively reduce the incidence of POPF in people with high risk of pancreatic fistula.Soft pancreas and thinner pancreatic duct are the risk factors of POPF.