Clinical Analysis Of Postoperative Compllcations After Pancreaticoduodenectomy

Objective:To investigate the risk factors of postoperative complications in patients undergoing PD and to analyze the causes of postoperative complications of PD and study measures for prevention and treatment of the complications.Methods:A retrospective review was performed of the medical records of 497 patients who undergoing PD between December 1999 to January 2015, which come from Tianjin third central hospital. To whether gastric anastomotic fistula after surgery, bravery intestinal anastomotic fistula and 20 kinds of complications as the dependent variable. First, we use the single-factor analysis to determine the occurrence of postoperative complications of PD influential factors, which including patients' age, gender, history of biliary tract surgery, abdominal surgery history etc. 48 complications, and then further into Logistic regression multivariate analysis, and ultimately determine the independent risk factors of PD complications.Results : 1.Whether intraoperative infusion plasma is the risk factors for postoperative gastrointestinal anastomotic fistula.2.The independent risk factors for postoperative bile intestinal anastomotic fistula is smaller common bile duct diameter.3 The independent risk factors for postoperative cholangitis include cirrhosis of the liver disease and no drainage of the pancreatic duct. 4. Plasma intraoperative no losses are independent risk factors of postoperative pulmonary infection.5. The history of rheumatoid arthritis is independent risk factors for postoperative pulmonary embolism.6. The independent risk factors for abdominal bleeding include higher Preoperative ASA score, hypertension, and male.7 The risk factors for postoperative abdominal infection include outside line preoperative biliary drainage, lower postoperative ALB,lower postoperative CHE, higher postoperative PT %, longer postoperative PT, longer pancreatic duct supporting tube length, smaller pancreatic duct diameter,and diagnosis of cholangiocarcinoma.8. The risk factors for postoperative liver abscess include postoperative lower CHE and male.9. No observation factor is the risk factor for liver failure.10. The risk factors for postoperative respiratory failure include not preoperative subtract yellow and higher preoperative TBIL.11. The risk factors for postoperative wound infection include a history of bile duct surgery, preoperative reduction of yellow(biliary drainage), lower preoperative CHE, postoperative application hormone, lower postoperative ALB, lower CHE, and postoperative PT extension.12. The risk factors for postoperative cholangitis include male, more interoperate blood loss and intraoperative blood transfusion.13. No observation factor is the risk factor for postoperative gastrointestinal anastomotic obstruction.14. The independent risk factors for postoperative gastric paralysis include age and postoperative application of somatostatin.15. The risk factors for postoperative cholangitis include female and deep venous thrombosis. 16. The independent risk factors for postoperative gastrointestinal bleeding include a history of high blood pressure and lower postoperative CHE. 17.Diabetes is the independent risk factor for postoperative heart function failure.18. The risk factors for postoperative pancreatic fistula include a history of high blood pressure,and a diagnosis of cholangiocarcinoma,.19. No observation factor is the risk factor for postoperative pancreatitis.20. The independent risk factors for postoperative stress ulcer include a history of cirrhosis, preoperative higher total bilirubin. Conclusions: The main complications after PD were pancreatic leakage,bile duct leakage, infection, gastric paralysis, and hemorrhage. Preoperative pay attention to general situations and laboratory indicators,intraoperative pay attention to the way of pancreatic anastomosis and the processing of various anastomotic, and good surgical expertise can decrease complications and morbidity rate.