Analysis Of Risk Factors Of Gastroparesis After Pancreatoduodenectomy And Its Diagnosis And Treatment

BACKGROUND and OBJECTIVE Pancreaticoduodenectomy(PD)was performed by Whipple[1]in 1935,after nearly a century of development,it has become a classic radical operation for carcinoma of head of pancreas,carcinoma of the ampulla of Vater,common bile duct cancer and malignant tumor of the duodenum.The scope of PD surgery includes resection of the pancreatic head and uncinate process,gallbladder,common bile duct below the hepatic duct,distal stomach,duodenum and part of the jejunum,as well as mesentery of uncinate process,lymph nodes and adipose tissue which are on the right,posterior and anterior sides of the Superior mesenteric artery(SMA),followed by digestive tract reconstruction,and at present,the Child reconstruction method is the most common way.With the development of PD,it has become a routine operation in the department of general surgery in hospitals.Because of its wide range of resection and complex anastomosis,postoperative complications are also increasingly attracted everyone’s attention,according to the relevant statistics,the incidence of complications is between 25%-45%[2].Postsurgical gastroparesis syndrome(PGS),also Delayed gastric emptying(DGE),is one of the most common postoperative complications of PD surgery,which affect the patient’s recovery,prolong the length of stay,and increase the economic burden.In this paper,a retrospective analysis is conducted,including all patients with PD surgeries,as well as their clinical data,in 5 years in Qilu Hospital of Shandong University.Then review and analyze the associated risk factors for gastroparesis after PD,and to explore its diagnosis,treatment and prevention measures.Finally reduce the incidence of gastroparesis syndrome after PD,and speed up the recovery of related patients.METHODS Retrospective analyses were conducted for the clinical data of 381 patients who was performed PD surgeries,from January 2010 to December 2014,in Department of General Surgery,Qilu Hospital of Shandong University.According to the inclusion criteria in this article,a total of 102 cases were excluded,a total of 279 cases were included.According to relevant literature and clinical experience,to select the following 12 factors that may affect the postoperative gastroparesis syndrome of PD:gender,age,preoperative hyperbilirubinemia,operative time,blood loss,precolonic gastrointestinal anastomosis,Braun anastomosis,perioperative anemia,perioperative hyperglycemia,perioperative hypoalbuminemia,postoperative use of somatostatin and postoperative abdominal complications(including but not limited to the biliary fistula and pancreatic fistula,infection,hemorrhage).According to the diagnostic criteria of gastroparesis syndrome after PD in this article,the patients were divided into PGS group and the control group.Then IBM SPSS 19.0 software was used for single factor chi square test to find out the possible risk factors,and to analyze whether there is statistical significance.After that,multivariate analysis was performed in Logistic Regression to determine the effects of these risk factors on PGS after PD.RESULTS Retrospectively analyze the clinic data of 279 patients undergoing PD,and find that there were 54 cases of PGS after operation,where incidence was 19.4%(54/279).The result of single factor chi square test was that age of patients,perioperative anemia,postoperative hypoproteinemia,Braun’s anastomosis,somatostatin and postoperative abdominal complications were the 6 factors relating to the occurrence of PGS(P<0.05);The result of Multivariate Logistic Regression analysis showed that perioperative anemia,hypoalbuminemia and postoperative abdominal complications were risk factors for PGS(OR>1,P<0.05),while the application of Braun’s anastomosis,somatostatin and similar drugs are the protective factors of PGS after pancreaticoduodenectomy(OR<1,P<0.05).CONCLUSIONS With the increasing prevalence of PD,postsurgical gastroparesis syndrome is more common as well.Although the exact cause is not clear,but most people tend to think that PGS is caused by a variety of factors together.Age of patients,perioperative anemia,postoperative hypoproteinemia,Braun’s anastomosis,somatostatin and postoperative abdominal complications were relating to the occurrence of PGS,and perioperative anemia,hypoalbuminemia and postoperative abdominal complications were risk factors for PGS,while the application of Braun’s anastomosis,somatostatin and similar drugs are the protective factors of PGS after PD.According to the results,we can actively take measures to prevent the occurrence of PGS,and reduce the incidence of PGS.Also it is helpful for us to take effective measures to shorten the course of the disease,accelerate the rehabilitation,and relieve the pain of the patients after the occurrence of PGS.It is necessary to ensure patient’s perioperative hemoglobin in the normal range,maintain the postoperative albumin levels above 30g/L.Do not forget the Braun anastomosis in the digestive tract reconstruction,careful intraoperative anastomosis of the digestive tract during surgery,and careful closure of blood vessels.Remember to apply somatostatin and other similar drugs,and rational use of antibiotics to prevent infection,to prevent postoperative complications such as biliary fistula,pancreatic fistula,infection and hemorrhage.All these measures can help to reduce the incidence of PGS.If PGS happens,active gastrointestinal motility drugs,acupuncture,physical therapy and other symptomatic treatment are helpful to relieve symptoms when exclude mechanical obstruction cases.