Risk Factors And Treatments For Bleeding After Pancreaticoduodenectomy-a Single-center Retrospective Analysis

Background:Pancreatoduodenectomy is a classic surgical method for the treatment of tumors in the head of the pancreas,lower segment of the common bile duct,ampulla,and duodenum.The surgery is complex and has many postoperative complications.The most common complications are pancreatic leakage,delayed gastric emptying,incision infection,and abdominal abscess.Among them,PPH is also one of the most dangerous complications,but there is currently no gold standard for the treatment of PHH.Objective:To analyze the risk factors of PPH and the experience and methods of clinical treatment.Methods:Collect clinical data of 495 patients who underwent PD surgery at the Second Affiliated Hospital of Nanchang University from August 2017 to April 2022,such as age,gender,hypertension,diabetes,chronic pancreatitis,ALB,Hb,total bilirubin,abdominal surgery history,preoperative biliary drainage,surgical mode,blood loss,intraoperative blood transfusion history,pancreatic duct diameter,vascular reconstruction,POPF,POBF,abdominal infection and pathological results,Statistical analysis was conducted to determine whether there was a significant difference between PPH and its death after treatment.Results:The clinical data of 495 patients undergoing PD surgery included 277 males and218 females,of which 471 were cured and 24 died(non PPH deaths accounted for37.5%,9/24;PPH deaths accounted for 62.5%,15/24);The incidence of postoperative pancreatic leakage,biliary leakage,and abdominal infection was 76.8%(380/495),9.3%(46/495),and 18.2%(90/495),respectively;422(85.3%)patients had malignant tumors,and only 73(14.7%)patients had benign diseases;Single factor analysis shows that AST(P=0.047),ALT(P=0.033),CA199(P=0.041),LPD(P=0.024),POPF(P=0.001),POBF(P=0.002),and abdominal infection(P<0.001)were risk factors for PPH.Multivariate logistic regression analysis showed that abdominal infection and POPF grading were independent risk factors for PPH(P<0.001,P=0.022,respectively).Conclusion:For patients such as AST,ALT,laparoscopic surgery,CA-199,POBF,POPF,POPF,and celiac infection leading to increased risk of postoperative bleeding,POPF and intra-abdominal infection are independent risk factors;For hospitals,the type of emergency intervention that patients with early and late bleeding should receive is unpredictable and cannot be limited to the same treatment,and the appropriate treatment according to the condition depends on the experience of the doctor;Early diagnosis and treatment of bleeding improves patient outcomes.