| Pancreaticoduodenectomy is one of the operations that involve more organs and more trauma in abdominal operation.The problem of postoperative complications has been troubling general surgeons,and the causes of complications are complicated.The overall complication rate of hemorrhage,pancreatic fistula,delayed gastric emptying,bile leakage,abdominal infection and pulmonary infection can be as high as 30%-50%.Moreover,the occurrence of complications may lead to prolonged hospital stay and increased economic expenses,etc,in sever cases,the patient may need to be operated on again and even die.In recent years,the importance of liquid therapy has been gradually recognized and applied in various surgical fields,there are also relevant studies in pancreatic surgery,among which the goal-directed fluid infusion in the concept of accelerated rehabilitation surgery is also used to accelerate the rapid recovery of patients after pancreatic surgery through liquid therapy.However,the quantity and quality of relevant studies are very limited,which leads to a great difference in the clinical implementation of liquid therapy for PD.Therefore,how to reduce the perioperative complications through better liquid treatment has become the key to improve the prognosis and recovery of patients,as well as the direction of general surgeons’future efforts.Through retrospective analysis,the purpose of this study was to determine the correlation between the amount of fluid therapy and postoperative complications,and to provide a basis for restrictive rehydration therapy for patients undergoing pancreaticoduodenal surgery,in the hope of providing guidance for clinical treatment.ObjectiveTo discuss the correlation between perioperative fluid volume and postoperative complications after PD and the risk factors of common postoperative complications,in order to provide a reliable basis for restrictive rehydration in patients undergoing PD and provide guidance for clinical treatment.The incidence of complications after PD can be reduced and the length of hospital stay can be reduced by reasonable amount of liquid therapy.MethodsRetrospective analysis of pancreaticoduodenectomy cases admitted to the first affiliated hospital of Dalian Medical University from December 2013 to December2018.The data were obtained from the medical record management database of our hospital,and the intraoperative and daily fluid infusion statistics were obtained from anesthesia records and doctor’s orders records.All enrolled cases were grouped according to the amount of liquid therapy:the median amount of infusion per kilogram of body weight per unit of time during the operation was taken,and all the patients were divided into two groups of high and low fluid infusion.According to the median fluid infusion per kg of body weight on the day of surgery,all patients were divided into two groups with High and low fluid infusion.Postoperative complications,the length of time were respectively compared between high and low group with different fluid infusion during operation,and postoperative complications,the length of time were also respectively compared between high and low group with different fluid infusion on the day of operation.At the same time,the associative risk factors of overall complications after PD and the major complications were analyzed comprehensively.Variables with statistical significance were used for Logistic multivariate regression analysis,and high risk factors for complications after PD were screened out to establish a regression prediction model.By using the Enter method to establish the regression equation:P=ExpiΣBiXi/1+ExpΣBiXi,calculate the relative risk of each variable.The prediction model was verified retrospectively.ResultsFrom December 2013 to December 2018,164 cases of pancreaticoduodenectomy patients were admitted to the first affiliated hospital of Dalian Medical University.After screening by the inclusion criteria,98 cases were enrolled,including 59 males（60.20%）and 39 females（39.80%）.Average age 60.08 years old,a total of 45 cases of complications（45.92%）,2 cases of pastoperative death（2.04%）,2 cases of re-operation（2.04%）,2 cases of biliary fistula（2.04%）,26 cases of grade B pancreatic fistula（26.53%）,3 cases of grade C pancreatic fistula（3.06%）,13 cases of pulmonary infection（13.27%）,24 cases of abdominal infection（24.50%）,9 cases of postoperative intraperitoneal bleeding（9.18%）,10 cases of gastric emptying disorder（10.20%）,5 cases of incision infection（5.19%）.The median amount of fluid infusion per Kg of body weight per unit time during the operation was 8.25ml/Kg/h（range4.05-20.4ml/Kg/h）.The median amount of fluid infusion per Kg of body weight per unit time on the day of surgery was 85.94ml/Kg/d（range:57.87-141.56ml/Kg/d）.Patients with intraopertive infusion more than 8.25ml/Kg/h,overall complications significantly higher（P=0.026）,hospitalization time significantly longer（P=0.008）,pancreatic fistula（P=0.004）,delayed gastric emptying（P=0.019）were all significantly increased;Patients with fluid infusion of more than 85.94ml/Kg/d on the day of surgery had significantly higher overall complications（P=0.001）,significantly longer hospital stay（P=0.040）,abdominal infection（P=0.010）,abdominal bleeding（P=0.036）,pancreatic fistula（P=0.004）,and delayed gastric emptying（P=0.019）.At the same time,it was found that long operation time,high intraoperative fluid volume,high operation day fluid volume,diabetes history were significantly correlated with overall postoperative morbidity（P<0.05）.Male,high intraoperative fluid volume,high operation day fluid volume,long operation time and large intraoperative blood loss were the risk factors for pancreatic fistula after PD（P<0.05）.History of diabetes,high intraoperative fluid volume,high operation day fluid volume,and pancreatic fistula were associated risk factors for abdominal infection after PD（P<0.05）.High intraoperative fluid volume,high operation day fluid volume,and pancreatic fistula were associated risk factors for abdominal hemorrhage after PD（P<0.05）.Variables related to overall complications were included in the Logistic regression model for multivariate analysis,and the results showed that all four variables were related to complications after PD.The action intensity was successively as follows:diabetes historyX4（OR=4.980）,operation time（T）X3(0R=1.354,intraoperative fluid intake per kilogram of body weight per unit time（IOF）X2（OR=1.335）and fluid intake per kilogram of body weight per unit time on the operation day（TF）X 1（OR=1.041）.Establishment of predictive regression model:P=1/[1+e（-8.693+0.04X1+0.289X2+0.303X3+1.605X4）],the sensitivity and specificity of postoperative complication in PD patients of the same type were 71.1%and 81.1%respectively.ConclusionsPerioperative restrictive fluid therapy plays an important role in the treatment of patients undergoing PD and the reduction of perioperative complications the higher amount of fluid per kilogram of body weight per unit time during the operation can lead to a significantly higher of postoperative complications,pancreatic fistula and delayed gastric emptying,and a significantly longer,postoperative hospitalization time;The higher amount of fluid per kilogram of body weight per unit time of operation day can lead to the significantly higher incidence of postoperative complications,pancreatic fistula,abdominal bleeding,abdominal infection and delayed gastric emptying,and the significantly longer postoperative hospitalization time.In patients with pancreatic fistula,abdominal hemorrhage,abdominal infection and other major complications,the amount of fluid per kg of body weight during operation and on the operative day was significantly higher than that in patients without complications.The prediction model can accurately determine the postoperative complications in PD patients of the same type. |
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