| Part 1: Clinical analysis of risk factors for clinical pancreatic fistula after distal pancreatectomy.Objective Based on the clinical data of 223 patients undergoing pancreatec tomy in our hospital,the risk factors of clinical pancreatic fistula after pancreatectomy were analyMethods In strict accorda nce with the inclusion and exclusion criteria,the clinical data of 223 patients who underwent pancreatectomy or pancreatectomy combined with splenectomy in the General Hospital of Ningxia Medical Univer sity from January 2012 to January 2022 due to benign and malignant diseases of the body and tail of the pancreas,pancreatic trauma,and peripheral pancreatic lesions were collected and analyzed retrospectively,According to the presence or absence of clinically relevant p ancreatic fistula,the patients were divided into two groups:non pancreatic fistula group(no,biochemical leakage)and clinical pancreatic fistula group(Grade B,Grade C pancreatic fistula).SPSS23.0 was used to statistically analyze t he patient’s medic al record information and conduct ge neral data statistics.The bivariate logistic regression analysis method was used to conduct one-way regression analysis.Multiple logistic regression analysis was performed on the data considered stati stically significa nt in the test level(P<0.05),Clinical data with a P value of<0.05 are considered as independent risk factors for clinically relevant pancreatic fistula after pancreatectomy.Results Of the 223 patients included in this study,32 had cl inically relevant pancreatic,fistula,accounting for 14.3%,and 1 died during perioperative period,accounting for 0.4%.Single factor regression analysis was carried out with binary logistic,and the data with test level p<0.05 were included in the multivariate logistic regression analysis.Finally,in 62 variables,it was found that the presence of diabetes(p<0.03),pancreatic texture(p<0.05),and location of pancreatic lesions(p<0.01)were significantly correlated with clinical pancreatic fist ula after pancreatectomy(p<0.05).Conclusion Diabetes,soft pancreas and the location of pancreatic lesions are independent risk factors for clinical pancreatic fistula after pancreatectomy.Part 2: The influence of diabetes and pancreatic texture on clinical pancreatic fistula after pancreatectomy: meta-analysisObjective In the first part,it has been analyzed that diabet es,soft pancreas and pancreatic tail lesions are indepe ndent risk factors for clinical pancreatic fistula after pancreatectomy.This part will search the previously published relevant literature for meta-analysis to further verify the influence of diabete s and pancreatic textu re(soft/hard)on clinical pancrea tic fistul a after body and tail pancreatectomy,and provide basis for perioperative prevention and treatment of pancreatic fistula after body and tail pancreatectomy.Methods Based on the newly define d criteria for posto perative clinical pancreatic fistula,we searched Chinese databases: CNKI,China Science and Technology Journal Database,China Biomedicine,Wan Fang Database,China Clinical Laboratory Registration Center,and English databases: Pub Med,Web of Science,Embase,Cochrane Library,and the Unite d States Clinical Laboratory Registration Center.According to the inclusion and exclusion criteria,the retrieved documents were gradually screened,and 17 relevant documents that met the zedinclusion criteria were finally selected.A meta-analysis was conducted using Revman 5.3 data analysis software.Results Among the 17 articles,12 articles were included in the study on whether pancreatic texture is a factor influencing clinical pancreatic fistula after pancreatectomy,1 article was exc luded from hetero geneity,and 11 articles were ultimately included in the study.A total of 1858 patients were included,including 1305 cases in the group without pancreatic fistula and biochemical leakage,and 553 cases in the group with clinically releva nt pancreatic fistula.It is concluded that soft pancreas is a risk factor for clinical pancreatic fistula after pancreatectomy(P.The study on whether diabetes is the influencing factor of clinical pancreatic fistu la after pancreatectomy of body and tai l included 5 arti cles,excluded 1 heterogeneous article,and finally included 4 articles.A total of 514 patients were included,including 415 patients without pancreatic fistula and biochemical fistula,and 99 patien ts with clinically relevant pancreatic fistula.It is concluded t hat soft pancreas is a risk factor for clinical pancreatic fistula after pancreatectomy of body and tail(P>0.05).According to the above research information,the diamond chart in the forest map falls on the invalid line,indicating that the risk of clini cal pancreatic fistula after DP betwe en people with diabetes and people without diabetes is not statistically significant,and people with diabetes are not risk factors for pancreatic fistula after pancreatectomy of body and tail.OR: 0.91 95%CI: 0.60-1.36。Conclusion The analysis results of this study show that the pancreatic texture is related to the occurrence of clinical pancreatic fistula after pancreatectomy of body and tail.Considering t hat it is a risk factor for pancreatic fistula after pancreatectomy of body and tail,and consistent with the analysis of the first part of clinical data,the clinical pancreatic fistula after pancreatectomy of body and tail is not significantly related to the presence or absence of diabetes.Due to the lack of research literature on the location of pancreatic lesions,meta-analysis cannot be included. |
