Clinical Analysis Of199Cases Operated With Pancreaticoduodenectomy

Background:Pancreaticoduodenectomy, reported by Whipple first in1935, is a kind of classic surgical procedure for cholangiocarcinoma of the distal common bile duct, pancreatic carcinoma, periampullary adenocarcinoma, chronic pancreatitis and other diseases that can result in obstructive jaundice. Because of the large operative range, the long operation time, referring to important organs and large damage to the body, the early complications of pancreaticoduodenectomy are still so many, although it has been improved in the past80years since it was reported for the first time.Objective:To research the surgical mortality rate, the incidence of common and severe complications and the influencing factors of these complications in patients received pancreaticoduodenectomy (PD).Methods:Collect the clinical information of199patients who received PD between July2005and July2010, and analyze them retrospectively. Discuss if the gender, age, chronic diseases, preoperative biochemical indicators, operation time, estimated amount of bleeding, blood transfusion, pathological types, histological grades and lymph node metastasis will be related to the occurrence of the complications.Results:We collected all the clinical data of the199patients who have been suffered with PD.The incidence of the postoperative complications in the whole patients is43.2%(86/199), of which single complication occurs in47patients (54.7%). The major complications are intra-abdominal infection (19.6%), biliary fistula (10.1%), delayed gastric emptying (9.0%), wound dehiscence and infection (9.0%), pancreatic fistula (9.0%), intra-abdominal hemorrhage (5.5%), gastrointestinal hemorrhage (3.0%).Whether the CA125is positive or not is related to the incidence of total complications, which in other words indicate that total complications incidence is higher in the group CA125(+) than that in the group CA125(-)(x2=5.708, P=0.017<0.05).Compare with the normal serum albumin, the hypoalbuminemia (<35g/L) will increase the incidence of pancreatic fistula(P=0.007). There is statistical difference in the incidence of postoperative intra-abdominal hemorrhage between the low estimated amount of bleeding group (<500ml) and the high group (≥500ml)(P=0.037<0.05). The operation time (≤5h vs>5h), CA125(negative vs positive), biliary fistula (no vs yes), pancreatic fistula (no vs yes), intra-abdominal hemorrhage (no vs yes) can influence the incidence of postoperative intra-abdominal infection(P-value is0.020,0.029,0.0001,0.002and0.008respectively).Conclusions:The incidence of complications is still so high in the patients suffered with PD, which prolong the hospital time, increase the hospital costs and reduce the quality of life significantly. The early mortality rate after PD is higher than other kinds of basic surgery, and the major cause of death are pulmonary infection and shock related to intra-abdominal hemorrhage. Hypoalbuminemia is a risk factor of postoperative pancreatic fistula. The massive amount of bleeding will increase the occurrence rate of intra-abdominal hemorrhage. The operation time, CA125, biliary fistula, pancreatic fistula and intra-abdominal hemorrhage play an important role in the occurrence of intra-abdominal infection.