Comparative Study Of Postoperative Complications Between Pancreatico Gastrostomy And Pancreatico Jejunostomy After Pancreatico Duodenectomy

Objiective: To explore the superiority of pancreaticogastrostomy throughstudying postoperative complications between pancreaticogastrostomy(PG)and pancreaticojejunostomy(PJ) after pancreaticoduodenectomy(PD).Simultaneously, to study the risk factors related to major postoperativecomplications after PD.Methods: We collected the datas of65patients，underwent PD inHepatobiliary Surgery, Fourth Hospital, Hebei Medical University betweenApril2010and June2013. Of which, twenty three cases of PG group, fortytwo cases of PJ group which was geted by randomized sampling method from300cases underwent PD. Counted the major postoperative complicationsincluding pancreatic fistula(PF), bleeding, delayed gastric emptying, stressulcer, pneumonia, pleural effusion, abdominal effusion, intraabdominalinfection and death. In order to explore the superiority of PG after PD, weanalysed the morbidity and the mortality of postoperative complicationsbetween PG group and PJ group. On the other hand, we used univariateanalysis to screen out the risk factors in12factors related postoperativecomplications(age, gender, history of abdominal surgery, hypertension,albumin, total bilirubin, carbohydrate antigen19-9, tumor diameter, diameterof main pancreatic duct, operative time, blood transfusion, whether usesomatostatin or not). For the more, we obtained the independent risk factorsthrough those screened factors by Logistic multivariate regression analysis.All statistical datas were analyzed by SPSS13.0statistical software, univariateanalysis was carried out by chi-square test, logistic regression analysis wasused for analysis of multivariate. The difference was statistically significant ifP<0.05. Results: There were23cases of PG group and42cases of PJ group in65patients underwent PD. Twenty cases(30.77%) suffered from postoperativecomplications in total. Four cases suffered from complications in the PGgroup, one case (4.35%) with bleeding, three cases(13.04%) with delayedgastric emptying，one case(4.35%) with stress ulcer, one case(4.35%) withpleural effusion, one case(4.35%) with abdominal effusion. Sixteen casessuffered from complications in the PJ group, of these, nine cases(21.43%) withpancreatic fistula, four cases(9.52%) with bleeding, one case(2.38%) withdelayed gastric emptying, five cases(11.90%) with stress ulcer, threecases(7.14%) with pneumonia, two cases(4.76%) with pleural effusion, fourcases(9.52%) with abdominal effusion, nine cases(21.43%) withintraabdominal infection. The incidences of pancreatic fistula andintraabdominal infection in PG group were lower than PJ group, and thedifference was statistically significant(P<0.05). The incidences ofpostoperative complications, bleeding, stress ulcer, pneumonia, pleuraleffusion and abdominal effusion in PG group were lower than PJ group, butthere was no significant difference(P>0.05). The incidence of delayed gastricemptying in PG group was higher than PJ group, there was no significantdifference too(P>0.05). No patients died in two groups. Univariate analysisrevealed that age, albumin, total bilirubin, diameter of main pancreatic ductand blood transfusion were the significant risk factors for postoperativecomplications(P<0.05). Age, albumin, diameter of main pancreatic duct andblood transfusion were the significant risk factors for PF and intraabdominalinfection(P<0.05). Age, albumin and blood transfusion were the significantrisk factors for bleeding(P<0.05). Multivariate analysis showed age, totalbilirubin and blood transfusion were the independent risk factors for thosepostoperative complications(P<0.05). Albumin and blood transfusion were theindependent risk factors for PF(P<0.05). Albumin was the independent riskfactors for intraabdominal infection(P<0.05).Couclusions: Compared with the PJ, the PG can definitely reduce therate of pancreatic fistula and intraabdominal infection. The occurrence of postoperative complications after PD was not only closely related withpatients’ age, performers’ experience, way of digestive tract reconstruction, butalso related with the level of albumin, the level of total bilirubin andintraoperative blood transfusion. We can decrease the occurrence ofpostoperative complications through evaluating risk of perioperative period,rectifying hypoproteinemia, improving liver function and coagulation function,performing precisely operation, stanching strictly, etc.