Risk factors of pancreatic fistula after pancreaticoduodenectomy and pancreaticojejunostomy
10.3760/cma.j.cn113884-20221123-00437
- VernacularTitle:PD贯穿式胰肠吻合术后胰瘘相关危险因素分析
- Author:
Daohai QIAN
1
;
Bin LIU
;
Shihang XI
;
Zhengchao SHEN
;
Guannan WANG
;
Xiaoming WANG
Author Information
1. 皖南医学院第一附属医院肝胆外科，芜湖 241001
- Keywords:
Pancreaticoduodenectomy;
Risk factors;
Penetrating pancreatojejunostomy;
Clinically-relevant postoperative pancreatic fistula
- From:
Chinese Journal of Hepatobiliary Surgery
2023;29(5):349-353
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To analyze the risk factors of clinically-relevant postoperative pancreatic fistula (CR-POPF) after pancreaticoduodenectomy (PD) and penetrating pancreaticojejunostomy (PPJ).Methods:The clinical data of 108 patients who underwent PD and PPJ in the Department of Hepatobiliary Surgery of the First Affiliated Hospital of Wannan Medical College from January 2017 to October 2022 were analyzed retrospectively, including 65 males and 43 females, aged 65.5 (54.2, 72.0) years. The incidences of POPF, biliary fistula, abdominal bleeding and other related complications were reviewed. The related factors of CR-POPF were analyzed by univariate analysis, and the statistically significant factors were included in multivariate logistic regression analysis.Results:A total of 108 patients were successfully treated with PD, including laparoscopic PD in 76 cases (70.4%) and open PD in 32 cases (29.6%). PPJ was performed in PD, including the continuous fashion in 39 cases (36.1%), intermittent fashion in 49 cases (45.4%) and modified continuous fashion in 20 cases (18.5%). The operation time was 390.0 (314.0, 480.0) min, the intraoperative blood loss was 200.0 (100.0, 384.0) ml, the postoperative hospital stay was 12.0 (10.0, 15.0) d, and the incidence of POPF (grade B + C) was 11.1% (12/108). Body mass index, pancreatic CT value and pancreatic duct size were the significant factors of CR-POPF (all P<0.05). Multivariate logistic regression analysis showed that age ( OR=0.895, 95% CI: 0.822-0.975), pancreatic CT value ( OR=0.812, 95% CI: 0.698-0.946) and pancreatic duct size ( OR=0.457, 95% CI: 0.220-0.952) were risk factors of CR-POPF after PPJ (all P<0.05). Conclusion:PPJ is a safe method of pancreaticoenterostomy, and CR-POPF may be related to younger patients, lower pancreatic CT value and the smaller pancreatic duct size.
