Analysis On Risk Factors Of Pancreatic Fistula After Pancreaticoduodenectomy

Introduction: Pancreatic fistula is one of the serious complications;in addition,it is one of the main death reason after pancreaticoduodenectomy.Although we have improved surgical technic in pancreas surgery and applied growth hormone release inhibiting hormone,and incidence rate of pancreatic fistula is lower than it is befor,incidence rate of pancreatic fistula is 10%-15%after pancreaticoduodenectomy still.It is very important to investigate the risk factor of the prevalence of pancreatic fistula because of the increased prevalence of mortality and complication caused by pancreatic fistula and the secondary infection and bleeding of the abdominal cavity post PD surgery.The main cause of pancreatic fistula post PD surgery relates to the alteration of the anatomic structure and pathophysiology of the pancreas and the surgery itself.â‘ the alteration of the anatomic structure and pathophysiology:the diameter of the pancreatic duct,the texture of the pancreas,haematoglobin concentration post PD surgery and the surgery history correlate with the prevalence of pancreatic fistula closely.The enlarged pancreatic duct,harden texture,correction of anemia postoperative and without upper abdominal surgery history induce a decreased prevalence of pancreatic fistula.â‘¡the injury of pancreas:injury during surgery but without in time discovery and correct treatment,especially the duct injury,the contusion or crush injury caused by the dragging or crushing during the liberation of the pancreas,the swelling panerease post surgery,the progressive necrosis and secondary infection can cause the secondary rupture of the pancreatic duct and the formation of pancreatic fistula.â‘¢the condition of the drainage of the pancreatic juice:the transfixion and compression of the duct,the unsmoothed effusion of the pancreatic juice,the increased inter duct pressure induced the rupture of the pancreatic duct.â‘£the mode of pancreaticojejunostomy:the pancreatic fistula of the stoma caused by the inaccurate stoma in the recombination of pancreas and digestive tract,the effusion of the pancreatic juice or the stoma is eroded by the pancreatic juice.On the whole,the prevalence of the pancreatic fistula is related to many factors,the prophylactic measure during surgery is mainly aimed to the manipulation of the stoma during the recombination of pancreas and digestive tract,but some risk factors should also be thought highly of,the measure can reduce the prevalence of pancreatic fistula include correction of anemia,improvement of nutrition condition,and the use of somatostatin.So the nutritional support pre-and postoperative and treatment of the complication,the perioperative medication,the modus operation,the improvement ofthe surgical technique are especially important.Objective: To investigate the risk factors and management of pancreatic fistula(PF) after pancreaticoduodenectomy(PD).Metholds: One hundred and eight patients who underwent PD consecutively at our hospital from January 2007 to March 2010 were reviewed.The management and outcomes of patients with pancreatic fistula were also evaluated.Thirteen factors which potentially affect the incidence of pancreatic fistula were analyzed with univariate and multivariate logistic regression model.Result: There are 8 pancreatic fistula examples from all the 108 patients. Univariate analysis showed the pancreatic duct size was significantly associated with pancreatic fistula after PD; the age, sex, serum bilirubin, the level of albumin, the level of haematoglobin, epigastric operation, the mode of pancreaticojejunostomy,the drainage for pancreatic duct ,pathologic type, the application of Somatostatin, the diabetes,and the therapy for jaundice besides the operation, were not associated with pancreatic fistula after PD.Conclusion: The pancreatic duct size was main risk factors of Pancreatic Fistula after Pancreaticoduodenectomy.Its relative risk was 6.73,and its odds ratio was 6.73.