|
Background: Pancreatic fistula is a serious complication of pancreatic surgery is pancreaticoduodenectomy (pancreaticduodenectomy PD) leading cause of death after surgery. Although pancreatic surgery through improvements in technology and the application of somatostatin, pancreatic fistula rate compared with the previous decline, but the PD postoperative pancreatic fistula rate is still 10% to 15%. Pancreatic fistula and intra-abdominal infections and bleeding secondary to increased PD mortality and postoperative complication rates, so study the risk factors of pancreatic fistula after pancreaticoduodenectomy for the prevention of the occurrence of pancreatic fistula is important . If pancreatic juice into the abdominal cavity is formed pancreatic ascites, if pancreatic tissue is wrapped around the formation of pseudocysts, pancreatic leakage or corrosion around the stomach wall, causing pancreatic duct communicates with the stomach or intestines compared with pancreatic fistula, pancreatic juice through drainage surface outflow tube or incision compared with pancreatic fistula or pancreatic fistula skin, clinical pancreatic fistula generally refers to external pancreatic fistula. Analysis of pancreatic fistula after PD and the main reason for many diseases caused by the pancreas anatomy and pathophysiology and the surgery itself: ① the pancreas anatomy and pathophysiology changes: duct diameter, pancreatic texture, postoperative hemoglobin determination and previous upper abdominal surgery is closely associated with pancreatic fistula, pancreatic duct dilatation, hard texture, and previous Supreme correct anemia caused by abdominal surgery reduced the incidence of pancreatic fistula: ② pancreatic injury: Intraoperative pancreatic injury failed to find and properly processing, especially pancreatic injuries, surgery free stretch or squeeze caused when the pancreas pancreatic contusion or crush injury, postoperative pancreatic swelling, progressive necrosis and secondary infection, resulting in rupture secondary to pancreatic duct, pancreatic fistula formation: ③ pancreatic drainage situation: the pancreatic duct was sutured, pressure, pancreatic juice outflow poor, increased pressure within the duct leading to rupture: ④ Pancreaticojejunostomy way: when the pancreas and digestive tract reconstruction anastomotic imprecise, pancreatic leak, corrode or pancreatic anastomosis mouth, caused by anastomotic pancreatic fistula. In short, PD postoperative pancreatic fistula and multiple factors, intraoperative preventive measures are mainly aimed at the pancreas and gastrointestinal anastomotic reconstruction process, but some of the risk factors for pancreatic fistula should also pay sufficient attention, such as patients to correct anemia, improve nutritional status, and somatostatin applications, to reduce the incidence of pancreatic fistula has a positive effect. Therefore, preoperative and postoperative nutritional support and effective treatment of complications, perioperative drug prevention and surgical options, improved surgical techniques is particularly important. Objective: To investigate pancreaticoduodenectomy (PD) after pancreatic fistula (PF) the related risk factors. Methods: A retrospective analysis of January 2007 - March 2010 period for the completion of the clinical data of 108 cases of PD, and the perioperative period may be associated with the 13 PF univariate and non-conditional Logistic multivariate analysis. 108 cases in men and 66 cases (61.11%) and 42 females (38.89%), male to female ratio was 1:0.62, aged 34 years to 81 years. Primary disease: 19 cases of pancreatic cancer, duodenal cancer, 38 cases, 36 cases of cholangiocarcinoma, ampullary carcinoma in 8 cases. Adopt Child tract reconstruction procedure, and pancreatic duct drainage tube placed inside the 37 cases, the drainage tube properly fixed, the remote place jejunum. 99 cases of pancreatic intestinal anastomosis, side anastomosis in 4 cases, 2 cases pancreaticogastrostomy: Among traditional invaginated pancreaticojejunostomy 76 cases, bundled pancreatojejunostomy 27 cases. Applications SPSSl3.0 statistical software for statistical processing. Univariate analysis according to the situation chi-square test and Fisher's exact test, test level α = 0.05. A statistically significant factors Logistic regression analysis to determine independent risk factors. Results: 108 cases of pancreatic fistula occurred in 8 cases, in which the pancreas into the jejunum anastomosis conventional sleeve 76 cases, 5 cases of pancreatic fistula, pancreatic jejunal set into bundled pancreatojejunostomy 27 cases, 2 cases of pancreatic fistula; duct stent tube drainage in 37 cases, 4 cases of pancreatic fistula, without stent placement in 71 cases, 4 cases of pancreatic fistula, pancreatic duct dilatation, 50 cases of pancreatic fistula, pancreatic duct dilatation in 58 cases no, pancreatic fistula occurred in 7 cases. The results of the statistical univariate analysis showed that the incidence of pancreatic fistula with age, gender, preoperative bilirubin, albumin level, hemoglobin level, upper abdominal surgery, Pancreaticojejunostomy way, the pancreatic duct drainage, histological type, somatostatin application or not, the presence or absence of diabetes, and the presence of preoperative jaundice treatment had no significant relationship, and significant relationship with the pancreatic duct diameter. Conclusion: duct diameter lt; 3mm of pancreatic fistula after pancreaticoduodenectomy risk factors, the relative risk (RR) was 6.03, while the duct diameter ≥ 3mm does not occur as a pancreatic fistula after PD advantage , its odds ratio (OR) was 6.73. But Benpian was a retrospective analysis of cases, there are limits to scientific and convincing, although prompt us to duct diameter lt; 3mm is pancreatic fistula after pancreaticoduodenectomy risk factors, clinical enough but arouse our attention while there is still the need for further analysis of a prospective cohort.
|