| Objective:To explore the risk factors and significance of pancreatic fistula after LPD,and to analyze the correlation between the postoperative complications by collecting and analyzing the clinical data of patients who underwent laparoscopic pancreaticoduodenectomy(LPD)for benign and malignant diseases of the pancreas or periampulla.Then exploring the related factors affecting the prognosis of patients after laparoscopic pancreaticoduodenectomy,in order to make early prediction and timely intervention of postoperative complications.Methods:The clinical data of 102 patients undergoing LPD in the Department of Hepatobiliary and Pancreatic Surgery of the Affiliated Hospital of Guizhou Medical University from September 2018 to May 2022 were analyzed retrospectively.According to the occurrence of grade B or C pancreatic fistula after LPD,patients were divided into non-pancreatic fistula group and pancreatic fistula group.Statistics were made on age,sex,BMI,basic medical history(hypertension and diabetes),history of abdominal surgery,preoperative ascites,preoperative jaundice reduction and specific surgical procedures,preoperative biochemical indexes(albumin,hemoglobin,platelets,glutamic pyruvic transaminase,glutamic oxaloacetic transaminase,total bilirubin),ASA grade,intraoperative blood loss,blood transfusion,bile duct diameter,pancreatic duct diameter,lesion size,operation duration,postoperative white blood cell count,albumin index,postoperative pathology and other clinical data.The clinical features and differences were compared between groups.The statistically significant indicators of univariate analysis were further incorporated into multivariate regression analysis to identify the independent risk factors of pancreatic fistula after LPD and draw the corresponding ROC curve for predictive analysis.Finally,the postoperative complications of the two groups were explored and the correlation analysis was conducted.Results:A total of 102 patients who underwent LPD were enrolled in the study.Retrospective analysis of the data showed that there were 58 males(56.9%)and 44females(43.1%).The average age was(57.4±11.2)years,and BMI was(21.9±2.8)kg/m~2.Postoperative pathological biopsy showed benign tumors in 12 cases(11.8%),malignant tumors in 90 cases(88.2%),pancreatic origin in 43 cases(42.2%),bile duct in 28 cases(27.5%),duodenum in 24 cases(23.5%)and ampulla in 7 cases(6.9%).22patients(21.6%)were complicated with postoperative pancreatic fistula,including 21cases of grade B and 1 case of grade C.6 patients(5.9%)were complicated with postoperative biliary fistula,1 case of postoperative chylous fistula and 1 case of postoperative intestinal fistula.21 patients(20.6%)were complicated with postoperative bleeding.21 patients(20.6%)were complicated with postoperative abdominal infection,14 patients(13.7%)with postoperative pulmonary infection,8patients(7.8%)with abdominal infection and pulmonary infection,4 patients(3.9%)with postoperative blood infection,and 1 patient with postoperative incision infection.17 patients(16.7%)were complicated with delayed gastric emptying after operation,including 10 cases of grade A,6 cases of grade B and 1 case of grade C.Univariate analysis showed that there were significant differences in intraoperative blood loss,pancreatic duct diameter,operation duration and postoperative albumin between non-pancreatic fistula group and pancreatic fistula group after LPD(P<0.05).Multivariate logistic regression analysis showed that pancreatic duct diameter(OR=0.581,95%CI:0.391-0.864)(P<0.05)and postoperative ALB(OR=0.840,95%CI:0.735-0.960)(P<0.05)were independent risk factors for postoperative pancreatic fistula in patients after LPD.ROC curve analysis showed that the AUC of pancreatic duct diameter,postoperative albumin(ALB)and the combination of the two were 0.724,0.697 and 0.814 respectively,the sensitivity were68.20%,63.64%and 86.40%,and the specificity were 81.30%,73.80%and 72.5%,respectively.The best cut-off values of pancreatic duct diameter and postoperative ALB were 3.5 mm and 34.10 g/L,respectively.Subgroup analysis showed that:1.When the diameter of pancreatic duct was less than 3.0 mm,the probability of clinical pancreatic fistula after LPD was 3.667 times higher than that of patients with pancreatic duct diameter>5.0 mm;2.When postoperative ALB<31.85 g/L,the probability of clinical pancreatic fistula after LPD was 3.472 times higher than that of postoperative ALB>38.43 g/L.Analysis of postoperative complications showed that pancreatic fistula after LPD was a risk factor of hemorrhage,abdominal infection,pulmonary infection and postoperative 30-day mortality.Conclusions:1.Intraoperative blood loss,pancreatic duct diameter,operation duration and postoperative albumin are correlated with pancreatic fistula after LPD.Pancreatic duct diameter<3.5 mm and postoperative serum albumin<34.10 g/L are the independent risk factors.The combination of the two factors has a good predictive value for the occurrence of pancreatic fistula after LPD.2.The risk of pancreatic fistula after LPD will be significantly increased when the pancreatic duct diameter<3.0 mm and postoperative serum albumin<31.85 g/L.3.Pancreatic fistula after LPD is correlated with abdominal or digestive tract hemorrhage,abdominal infection,pulmonary infection and postoperative 30-day mortality. |
