Analysis Of Influencing Factors Of Early Complications After Pancreaticoduodenectomy

Objective:To research the incidence of early complications and the influencing factors of these complications in patients received pancreaticoduodenectomy(PD).Methods:Collect the clinical information of 180 patients who received PD between January 2015 and December 2016 in the general surgury of the first affilicated hospital of Soochow University,and analyze them retrospectively.Discuss if the gender,age,chronic diseases,preoperative and postoperative biochemical indicators,operation mode,operation time,amount of bleeding,blood transfusion and pathological indicators will be related to the occurrence of the complications.Results:We collected all the clinical data of the 180 patients who have been suffered with PD.The incidence of the postoperative early complications in the whole patients is32.2%(58/180),of which single complication occurs in 58 patients is 46.6%(27/58).The multiple complications occurs in 58 patients is 53.4%(31/58).The major complications are intra-abdominal infection(16.7%),pancreatic fistula(12.8%),delayed gastric emptying(10.6%),biliary fistula(8.9%),postoperative hemorrhage(7.2%),wound problem(4.4%),early death(1.1%).The preoperative TBIL(≥171umol/L/<171umol/L),preoperative serum albumin(≥35g/L/<35g/L),postoperative serum albumin(≥35g/L/<35g/L),amount of bleeding(≥1000ml/ < 1000ml)can influence the incidence of total complications(P-value is0.0001 、 0.001 、 0.0001 、 0.0002 and 0.0001 respectively).The preoperative TBIL(≥171umol/L/ <171umol/L),preoperative serum albumin(≥35g/L/<35g/L),postoperative serum albumin(≥35g/L/<35g/L),operation time(≥6h/<6h),pancreatic fistula(no/yes),biliary fistula(no/yes)can influence the incidence of postoperative intra—abdominal infection(P-value is 0.0001 、 0.0001 、 0.0388 、 0.0112 、 0.000 、 0.0001 and 0.0001respectively).The preoperative TBIL(≥171umol/L/<171umol/L),preoperative serumalbumin(≥35g/L/<35g/L),postoperative serum albumin(≥35g/L/<35g/L),operation time(≥6h/<6h),amount of bleeding(≥1000ml/<1000ml),pancreatic texture(hard vs soft),pancreatic duct diameter(<3mm/≥3mm)can influence the incidence of pancreatic fistul(P-value is 0.0001、0.0001、0.012、0.0344、0.0099 and 0.0001 respectively).Patient sex(male/female),the preoperative TBIL(≥171umol/L/<171umol/L),operation time(≥6h/<6h),pancreatic fistula(no/yes)can influence the incidence of delayed gastric emptying(P-value is 0.0169 、 0.0001 、 0.0137 and 0.0002 respectively).Preoperative TBIL(≥171umol/L/<171umol/L),postoperative serum albumin(≥35g/L/<35g/L),amount of bleeding(≥1000ml/<1000ml)can influence the incidence of biliary fistula(P-value is0.0131 、 0.0001 、 0.0322 、 0.0247 、 0.0115 respectively).Amount of bleeding(≥1000ml/<1000ml),pancreatic fistula(no/yes),biliary fistula(no/yes)can influence the incidence of postoperative hemorrhage(P-value is 0.0047 、 0.0143 and 0.0001respectively).Conclusions:The incidence of complications is still so high in the patients suffered with PD,which prolong the hospital time,increase the hospital costs and reduce the quality of life significantly.The early mortality rate after PD is higher than other kinds of basic surgery,and the major cause of death is postoperative hemorrhage.Preoperative severe jaundice,preoperative and postoperative hypoproteinemia,intraoperative massive hemorrhage can increase the incidence of total complications.The preoperative severe jaundice,preoperative and postoperative hypoproteinemia,long operation time,pancreatic fistula,biliary fistula can increase the incidence of postoperative intra-abdominal infection.Preoperative severe jaundice,preoperative and postoperative hypoproteinemia,long operation time,intraoperative massive hemorrhage,soft pancreatic texture,Pancreatic duct diameter <3mm can increase the incidence of pancreatic fistul.Female patients,Preoperative severe jaundice,long operation time,pancreatic fistula can increase the incidence of delayed gastric emptying.Preoperative severe jaundice,postoperative hypoproteinemia and intraoperative massive hemorrhage,can increase the incidence of biliary fistula.intraoperative massive hemorrhage,pancreatic fistula,biliary fistula can increase the incidence of postoperative hemorrhage.