| Background: With the increasing incidence of pancreatic tumors year by year,spaceoccupying lesions of the pancreatic body and tail have become a health hazard.Pathologically,cancers of the pancreatic body and tail,neuroendocrine tumors,solid pseudopapilloma,serous and mucinous cystadenomas are common types.Distal pancreatectomy(DP)is the standard operation for tumor of pancreas body and tail,benign disease generally was choosen to keep the spleen,borderline and malignant tumor in pancreatic body and tail were performed pancreatectomy combined with spleen.However,there were many complications after the operation,of which the clinically relevant postoperative pancreatic fistula(CR-POPF)was the most common complication.CR-POPF affected the postoperative recovery of pancreatic surgery patients,significantly increased the length of hospital stay and hospital costs,and sharply decreased the quality of patients in the short term after surgery.How to reduce the incidence of pancreatic fistula after DP surgery is now a topic of concern to all pancreatic surgeons,and many high-quality randomized controlled studies have been carried out,but none of them have yielded satisfactory results.The predictive factors and preventive measures of pancreatic fistula after pancreatic resection still need more research and exploration.Objective: To analyze the high risk factors of clinically related pancreatic fistula after distal pancreatectomy,so as to try to predict the occurrence of pancreatic fistula through high risk factors,achieve early detection and early intervention,reduce the severe complications caused by CR-POPF,and provide ideas and starting points for further research.Methods: The preoperative and the first day information after pancreatectomy in 154 patients admitted to Anhui provincial hospital from January 2013 to January 2018 were retrospectively collected,sorted and analyzed using the Lianzhong case browsing system.After screening,29 clinical factors were analyzed using SPSS22.0,and the significance level was set as P < 0.05.Continuous variables were expressed as mean ±standard deviation,independent sample t test was used for continuous variables in univariate analysis,and chi-square test was used for categorical variables.Logistic regression was used for multivariate analysis,and the receiver operating characteristic(ROC curve)was used for the determination of the critical value.Grading criteria for pancreatic fistula were adopted the standard which was updated by the international pancreatic fistula research group in 2016.Results: Univariate analysis of postoperative pancreatic fistula after DP: body mass index(P = 0.04),preoperative ALT(P = 0.04),preoperative prealbumin level(P = 0.001)and prealbumin level on the first day after surgery(P = 0.04),the drain fluid volume on the first postoperative day(P = 0.003),postoperative blood glucose level(P = 0.03),complicated with diabetes mellitus(P = 0.01),and ASA score(P = 0.02)were high risk factors of the clinical relevance of pancreatic fistula occurred.Multivariate analysis suggested that the preoperative ALT level(OR=0.98,P=0.03)and the drainage volume on the first day after surgery(OR=0.99,P=0.02)were independent risk factors for the occurrence of clinically relevant pancreatic fistula.ROC curve analysis results indicated that when the drainage volume on the first day >87.5ml,the incidence of CRPOPF increased significantly(30.6% and 11.9%,P=0.004),with a sensitivity of 63.3% and a specificity of 65.3%.When the preoperative ALT level was >20.5IU/L,the incidence of CR-POPF significantly increased(30.7% and 13.9%,P=0.011),with a sensitivity of 53.3% and a specificity of 71.0%.Conclusion: Based on 154 cases of distal pancreatectomy patients perioperative data analysis,it is concluded that the high risk factors of CR-POPF after DP are body mass index,preoperative glutamic acid transaminase level,preoperative prealbumin level and prealbumin level on the first day after surgery,postoperative blood glucose level,complicated with diabetes mellitus,ASA score,preoperative ALT and the drain fluid volume on the first postoperative day.Among them,preoperative ALT and the drain fluid volume on the first postoperative day were the independent risk factors.This conclusion needs to be further confirmed by randomized controlled studies... |
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