Risk Factors Of Postoperative Complications In242Patients After Pancreaticoduodenectomy

Pancreaticoduodenectomy, as a classical surgical operation, is widelyapplied to the diseases in pancreatic head, middle and lower segment ofcommon bile duct and ampulla of Vater. The resection range ofpancreaticoduodenectomy includes the caput pancreatis（include the uncinateprocess of pancreas），distal common bile duct include gall bladder, distalstomach, duodenum, part of proximal jejunum, clear away the lymphonoduson hepatoduodenal ligament, celiac artery, around the head of pancreas androot segment of mesenteric blood vessels, then proceed to the digestive tractreconstruction with Child method which include pancreaticojejunostomy,choledochojejunostomy, gastrointestinal anastomosis. PD operation whichinvolved in large area excision needs to be taken much time and usually injurynormal organs, in addition, patients usually suffer with some diseases beforeoperation such as severe obstructive jaundice and malnutrition, therebyleading to the occurrence of postoperative complications, and even morethreaten the patients’ life. In recent years, along with the development andapplications of modern imaging techniques, the leap progress of surgicaltechnology and the optimize of perioperative period treatment,Pancreaticoduodenectomy received a speedy progress and became a safetytherapeutic means being generally accepted. However, because of thecomplexity and difficulty, pancreaticoduodenectomy continues to be adangerous operation. Recently the operative mortality after PD hassignificantly declined to3to5%, while the incidence of postoperativemorbidity remains high ranging from30%to65%. The complications afterPD mainly include bleeding (such as gastrointestinal bleeding orintraabdominal bleeding), pancreatic fistula, biliary fistula, prolonged gastricemptying, infection (such as intra-abdominal infection, abdominal abscess, pulmonary infection, wound infection), MODS and other complications suchas wound dehiscence, ileus, pancreatitis and so on. How to reduce theincidence of complications after PD and improve the prognosis of patients isthe most urgent issue to solve at the moment. There were many risk factorsabout complications after PD that have been reported, such as age, gender,associated comorbidities, preoperative bilirubin level, operation time, thediameter of main pancreatic duct(MPD), texture of the remnant pancreas, themode of pancreaticojejunostomy, the mode of choledochojejunostomy andgastrointestinal anastomosis and so on. However, the risk factors of thesecomplications is still controversial.Objective: To study the risk factors which may affect the postoperativecomplications after PD. And study the risk factors that may related to theimportant complications after PD incule bleeding, infection and pancreaticfistula respectively.Methods:242patients undergoing PD in Hebei Medical Universityfourth hospital hepatobiliary surgery between January2010and December2012were reviewed retrospectively. Of the242patients,137were males and105females with a median age of59years, ranging from30to80years.There are216malignant and26benign diseases. Among the malignant are57in pancreas and159around ampullary. Among the benign are15in pancreasand11around ampullary. The study collected the general information,preopreative examination, operation data and postoperative data of thesepatients, and select15risk factors which may related to the complicationsafter PD (age, gender, comorbidity, ALB, TBIL, ALT, CA-199, operative time,blood transfusion, tumor location, tumor location, diameter of main pancreaticduct, Whether use somatostatin or not, lymph node metastasis). Screen out therisk factors that are relation to complication after PD by univariate analysis.And to screen out the risk factors that are relation to the importantcomplications include bleeding, infection and pancreatic fistula respectively.Then to obtain the independent risk factors by Logistic multivariate regressionanalysis. Statistical method: all data in the study analyzed by SPSS19.0 statistical software, measurement data use t-test and enumeration data usechi-square test, multivariate analysis use Logistic regression analysis.Difference is statistically significant if P＜0.05.Results: Of these242patients after PD, the morbidity is42.10％(n=102),mortality is1.20%(n=3). Among the102patients suffered with complications,21.00％(n=51) infection,10.70％(n=26)，15.30％(n=37) pancreatic fistula，1.24％(n=3) prolonged gastric emptying，2.06％(n=5) reoperation，othercomplications4.54％(n=11). Univariate analysis shows that age, comorbidity,blood transfusion and tumor location were the significant risk factors for themorbidity(P<0.05).Age, blood transfusion, main pancreatic duct diameterwere the significant risk factors for postoperation infection. Whether usesomatostatin or not and TBIL were the significant risk factors forpostoperation bleeding. Age, main pancreatic duct diameter were thesignificant risk factors for postoperation pancreatic fistula. Multivariateanalysis shows, age, blood transfusion and tumor location were theindependent risk factors for the morbidity. Age, blood transfusion and mainpancreatic duct diameter were the independent risk factors for postoperationinfection. Whether use somatostatin or not and TBIL were the independentrisk factors for postoperation bleeding. Age and main pancreatic duct diameterwere the independent risk factors for postoperation pancreatic fistula.Conclusions: Pancreaticoduodenectomy is a kind of complicated andhigh-risk procedure. Postoperative complications are not only depends on thesurgeon’s operation technique, and also closely related with age,intraoperative blood transfusion and tumor location. Age, TBIL and tumorlocation can be used to evaluate the risk of PD before operation. Improve theliver function and coagulation function before operation, careful operationandhemostasis completely during operation, may reduce the occurrence ofpostoperative complications.