To Analyze The Risk Factors Of Postoperative Complications Of Pancreaticoduodenectomy In Patients With Papillary Carcinoma Of The Duodenum

Objectives Retrospective analysis of clinical and pathological data of 85 cases of duodenal papillary carcinoma who underwent pancreaticoduodenectomy in our first affiliated hospital of guangxi medical university.Retrospective analysis of risk factors associated with complication of pancreaticoduodenectomy and discuss the reconstruction of digestive tract anastomosis and postoperative complications of additional correlation.To provide theoretical basis and clinical reference for the prevention of postoperative complications of pancreaticoduodenectomy.Methods From January 2013 to January 2017 85 cases of duodenal papillary carcinoma underwent pancreaticoduodenectomy in first affiliated hospital of Guang Xi Medical University were retrospectively collected.All cases were diagnosed by gastroscopy and pathological report of biopsy taken during gastroscopy.All patients underwent pancreaticoduodenectomy,child,age,sex,operative time,blood loss,preoperative serum total bilirubin,preoperative albumin,hemoglobin,pancreatic texture as observation factors to postoperative pancreatic fistula,hemorrhage,and infection as the dependent variable were taken.Statistical Analysis: The clinical data were analyzed by using univariate analysis and then two categories of non-conditional stepwise logistic regression model was used for multivariate analysis.Results1.85 cases of duodenal papilla cancer patients underwent pancreaticoduodenectomy within 1 months after the complications occurred in 30 cases(35.3%).The distribution of pancreatic fistula in9 cases,bleeding in 10 cases,infection in 11 cases,accounting for 10.6%,11.8% and 12.9%,respectively.2.Univariate and logistic multivariate analysis were used: The risk factors of pancreatic fistula were gender(male),preoperative low hemoglobin(<90g / L),soft pancreatic texture and the absence of Brown anastomosis.Age ? 70 years old,preoperative high bilirubin ? 171 umol / L,postoperative pancreatic fistula and abdominal infection were risk factors for postoperative bleeding.Age ? 70 years old,preoperative anemia(<90g / L),diabetes,preoperative albumin <30g / L,preoperative and postoperative blood transfusion,intraoperative blood loss ?800ml,indwelling gastric tube time> 5 days are the risk factors of postoperative infection.Logistic multivariate analysis showed that absence of Brown anastomosis and soft pancreatic texture are the independent risk factors of pancreatic fistula.Preoperative hyperbilirubin,postoperative pancreatic fistula and intraperitoneal infection were independent risk factors for postoperative bleeding.Diabetes was an independent risk factor of postoperative infection.Conclusion Soft pancreas were more prone to pancreatic fistula,Brown anastomosis can decrease the rate for pancreatic fistula after pancreaticoduodenectomy.High preoperative bilirubin,abdominal infection and pancreatic fistula formation were more prone to postoperative bleeding.Diabetic was more prone to abdominal infection and formation of pancreatic fistula.