| Objective To analyze the risk factors and turnover of pancreatic fistula(PF) after pancreaticoduodenectomy(PD), in order to reduce and prevent PF after PD. Methods A hundred and seventy one patients who underwent PD consecutively at Ningbo Lihuili Hospital from February 2001 to December 2007 were reviewed retrospectively. The management and outcomes of patients with PF were also evaluated.The factors which may potentially affect the incidence of PF were analyzed with univarite and mulivarite logistic regression model. Results Of the 171 patients, the overall morbidity and hospital mortality were 23.40%(40/171) and 4/171(2.34%) respectively,and PF occurred in 13 patients7.60%(13/171).PF was account for 42.50% in the overall morbidity.Of the 13 patients with PF,10 had successful management conservatively with effective drainage.In the other 3 patients who had intra-abdominal abscess, 1 patients refuse reoperation died of multiple organ failure,2 patients underwent reoperation for wide drainage,one survived,another died.The mortality of PF was 15.38% (2/13) ,which was account for 50 % of overall mortality.Patients with PF had significantly higher morality than those without PF(P=0.001). In univarite analysis,texture of the remnant pancreas,pancreatic duct size,pancreaticoenteric anastomosis type, hemoglobin before operation were related to occurrence of PF.Multiariate logistic regression analysis revealed that normal texture of the remnant pancreas and pancreatic duct size(<3mm) were independent risk factors(P<0.05). Conclusions Pancreatic duct size and texture of the remnant pancreas are the independent risk factors of occurrence of PF after PD.If the optimal pancreatojejumal anastomotic technique is selected according to pancreatic duct size texture of the remnant pancreas and experience of the surgeon,the incidence of PF can be reduced effectively.Early diagnosis and management of PF and other severe complications associated with PF are important to improve its outcome. |
PDF Full Text Request