External Versus Internal Of The Main Pancreatic Duct Stenting Drainage For The Efficacy After Pancreaticoduodenectomy

Objective:Pancreatoduodenectomy,namely Whipple surgery,Is the main choice of treatment for patients with tumors of hea-d of pancreas and periampullary tumors,Although there are Conti-nuous operation and anastomotic methods on improvement,Howe-ver,complications such as postoperative pancreatic fistula is still s-taying at a high level,In view of the postoperative pancreatic fis-tula is improved more on the pancreatic anastomosis site,Such as anastomotic metho ds,sutures,the type of stitching,biological fib-rin glue,pancreatic stents and the like,Including the use of the pa-ncreatic stents is an important progress,and for the resection of pancreas duodenum is of great significance,Nevertheless,there is n-o consistent view on the curative effect between internal stent a-nd external stent.This study by comparing the curative effect betw-een internal stent and external stent,to understand the relationsh-ip between different drainage and the post operative complications,Providing reference for clinical decision making.Method:From January 2014 to November 2016,67 cases clinical data of pancreatic resection of the No.1 Hospital of Dalian Medical University were retrospectively analyzed.All patients underwent PD and diagnosised confirms PD as the preferred solution,the without stent drainage ? Distant organ metastasis patients and the lack of Medical records patients are excluded in this research.In total 67,Divided into group internal stent(the pancreatic duct stents in jejunum)and group external stent(Stent drainage of the pancreatic duct pass through the intestinal wall and abdominal wall out of the in vitro).group external stent 42,group internal stent 25,analyze of two groups of patients of intraoperative and postoperativeindex each difference indexes(Leading indicator:POPF;Secondary indicators:Operative time,Intraoperative blood loss,Perioperative death,Hospital stay,Reoperation,DGE,Intra-abdominal infection,Intra-abdominal hemor rhage and other indicators),comparing the curative effect betw-een internal stent and external stent.risk factors of POPF(Pancreatic duct size?Pancreas texture?Jaundice time?TBil and other indicators)were also explored in this study.Results:internal stent of the patients with a total of 25 people,no patients were death,external stent of the patients with a total of 42 people,no patients were death,the incidence of entire postoperative complications was 59.7%,the int ernal stent of the incidence of complications was 56%,the external stent of the incidence of complications was 61.9%;Within the overall incidence of postoperative pancreatic fistula was 20.9%,24% incidence of the internal stent of the pancreatic fistula,external drainage of POPF rate 19%,there was no statistically significant difference between two groups(P > 0.05);Internal stent and external stent group in gender,age,total bilirubin,albumin,intraoperative blood loss,operative time,pathological diagnosis,the overall incidence of complications has no stati stical significance(P > 0.05);Texture is an important factor of POFP pancreas(P < 0.05),POPF has nothing to do with sex,operation time,age,etc(p > 0.05).Conclusion:External and Internal stent of pancreatic duct in pancreaticoduodenectomy are effective,safe and feasible.In the aspects of total complications,There are no significant differences in the pancreatic fistula,And there is also no significant difference between various complications including pancreatic fistula,But internal stent increased the occurrence of pancreatic fistula of B level or above.The number of cases of this study is limited,still need large sample research.