Propensity Score Matching Study Of The Prevention Of Complications After Pancreaticoduodenectomy Between Different Ways Of Pancreatic Duct Stent

BackgroundPancreaticoduodenectomy(PD)is the most complex operation of general surgery,and postoperative pancreatic fistula is the most serious complication.Pancreatic duct stent is recognized as one of the effective measures to prevent pancreatic fistula.However,the comparison between the two stent methods,namely internal drainage and external stent,is still controversial.Thus,it is necessary to compare the incidence of various postoperative complications between them scientifically and systematically.ObjectiveThis study aimed to compare the differences in the incidence of postoperative complications after PD among different methods of pancreatic duct stent drainage,and provide clinical evidence for current controversial issues,thus providing a reference for clinicians to make decisions.MethodsThe case data of all 1443 patients who underwent PD in our hospital from January2006 to December 2017 were collected.1193 cases were selected according to inclusion and exclusion criteria and divided into internal stent and external stent groups according to the method of pancreatic duct stent.Propensity score matching(PSM)analysis was performed on the included patients.After PSM,670 patients were included,529 in the internal drainage group and 141 in the external drainage group.Various factors were compared between the two groups.No significant difference in factors was found between the two groups.The outcome variables were statistically analyzed and compared between the two groups.ResultsThe incidence of pancreatic fistula was 12.48% in the internal stent group and 6.38%in the external stent group.In the internal stent group,7.56% of the patients required postoperative abdominal puncture catheter drainage,while the figure was 0.71% in the external stent group,with statistically significant difference.Next,univariate analysis and binary logistic regression was performed for each possible risk factor.The risk factors for postoperative pancreatic fistulas included age of the patient,association with gastrointestinal disease,history of epigastrium surgery,method of pancreatic stent,nidus size and location,while the risk factors for postoperative abdominal puncture catheter drainage included age of the patient,association with liver disease,method of pancreatic duct stent and nidus location.ConclusionCompared with internal stent of the pancreatic duct,external stent had advantages in preventing pancreatic fistula and reduced the possibility of postoperative abdominal puncture catheter drainage for patients.