Risk Factors Of Chylous Fistula After Pancreatic Surgery:a Meta-analysis

ObjectivePancreatic surgery involves multiple organs,complex anatomy,high surgical risks,Many postoperative complications and management,which make many surgeons afraid to try.Chylous fistula is a rare postoperative complication,Many doctors are unfamiliar with its risk factors,pathogenesis,and therapeutic measures,They often appear to misdiagnose and missed diagnose.Therefore,This article systematically evaluates the risk factors of chylous fistula after pancreatic surgery by evidence-based medicine,and discusses the pathogenesis and prevention countermeasures,In order to explore the pathogenesis,the preventive and therapeutic measures.MethodsSearching PubMed、Embase、The Cochrane Library foreign databases,CNKI、WanFang、VIP Chinese database through the internet,Searching the article published in domestic and foreign journals and related risk factors of chylous fistula after pancreatic surgery from the establishment of the databases to December 2018,According to the selection and exclusion criteria,screening qualified literatures,and evaluate the quality of article.Eventually,The clinical data were meta-analyzed by Review Manager 5.3 software,with Odds ratio(OR)and 95% confidence interval(CI)as effect value indicators.ResultsAccording to the selection and exclusion criteria,six articles are related to risk factors of chylous fistula after pancreatic surgery were finally included.A total of 9,767 patients underwent pancreatic surgery,of which 414 cases were chylous fistula and 9,353 cases were non-chylous fistula,the incidence rate of chylous fistula was 4.2%.The data to be included: gender,diabetes,focal pancreatitis,admission diagnosis,surgical approach,combined vascular resection,abdominal aortic dissection,postoperative pathology,and early enteral nutrition were discussed.The Meta-analysis’ s results showed that the incidence of postoperative chylous fistula in the male group had no statistical difference compared with the female group(OR 0.79,P = 0.16).The incidence of chylous fistula after pancreaticoduodenectomy(Pancreaticoduodenectomy,PD)group is higher than the distal pancreatectomy(Distal pancreatectomy,DP)group.The incidence of postoperative chylous fistula in PD group is not significantly different from that in pylorus preserving pancreaticoduodenectomy(Pylorus Preserving Pancreaticoduodenectomy,PPPD)group,and there is no statistical difference between the two groups in the surgical approach and the occurrence of postoperative chylous fistula(PD vs DP: OR 0.89,P= 0.35;PD vs PPPD: OR 1.34,P=0.37).Preoperative diabetes(OR 1.30,P=0.03),Focal pancreatitis(OR 5.17,P=0.002),Admission diagnosis of cancer(OR 1.44,P=0.002),Intraoperative combined vascular resection(OR 1.20,P=0.0006),abdominal aortic dissection(OR 9.01,P<0.00001),postoperative pathological malignancy(OR 1.44,P=0.002)and early enteral nutrition(OR 5.17,P<0.00001)are closely related to the occurrence of postoperative chylous fistula.ConclusionThe incidence of postoperative chylous fistula after pancreatic surgery is poor related to the gender,and there is no significant difference in the incidence of postoperative chylous fistula between different surgical methods.Preoperative diabetes,focal pancreatitis and admission diagnosis of cancer,intraoperative combined vascular resection,abdominal aortic dissection,postoperative pathological malignancy and early enteral nutrition are the risk factors for postoperative chylous fistula.Diagnosis and treatment of chylous fistula after pancreatic surgery is difficult.Careful operation during the operation and management of lymphatic vessels are the key.Prevention is more important than treatment for high-risk patients.Most chylous ascites can be cured by conservative treatment.When conservative treatment is ineffective,positive intervention or surgical intervention can also obtain a good prognosis.