Clinical Difference And Treatment Of Postoperative Pancreatic Fistula Between Mixed Pancreatic Fistula And Simple Pancreatic Fistula

Background and purposePancreatic fistula is the most common complication after pancreatic surgery,and it can be divided into two types: mixed pancreatic fistula(MPF)and simple pancreatic fistula(SPF)according to the composition of the drainage.This study will introduce the clinical characteristics of the two types in detail,compare the differences in risk factors and infection flora,and provide new ideas for clinical antibiotic selection and surgical intervention.MethodsThis retrospective analysis was performed on 336 patients with pancreatic related surgery who were treated in the First Affiliated Hospital of Harbin Medical University from August 2019 to December 2020,and some cases were excluded according to the criteria.Surgical methods were divided into two groups: MPF group of 104 cases(66.2%)after pancreaticoduodenectomy,subtotal pancreatic resection and pancreatico-digestive tract reconstruction,etc.SPF group of 53 cases after distal pancreatectomy or partial pancreatectomy example(33.8%).Univariate analysis and multivariate Logistic regression analysis were used to analyze independent risk factors,and a table was drawn to compare the distribution of bacterial spectrum,infection characteristics and treatment methods of complications.ResultsThere were 157 patients with postoperative pancreatic fistula,including MPF(n=104,63.4%),4 deaths(3.8%),and SPF(n=53,85.5%),but no deaths.There were significant differences in gender,smoking history,alcohol abuse history,age,length of hospital stay,operation time,and intraoperative blood loss between the MPF and SPF groups.Men are more prone to MPF,while women with SPF are more common.Smoking,alcohol abuse,prolonged operative time,and aging all increase the incidence of MPF.In addition,MPF patients had significantly longer hospital stay than SPF patients.The probability of postoperative grade B/C pancreatic fistula(41.3% vs 9.5%)and serious complications(Clavien-Dindo grade≥grade III,14.4%vs 5.5%)in the MPF group were higher than those in the SPF group.However,there was no significant difference in nutritional indicators such as white blood cell count and serum albumin level.Logistic regression analysis showed that smoking history was an independent risk factor for MPF,and age had a positive coefficient in the model.Enterococcus and Enterobacter were the most common in MPF group,and the probability of blood fungal infection reached 10.5%.Pseudomonas aeruginosa and Klebsiella pneumoniae were more common in the SPF group.Blood is more specific than drainage bacterial cultures.Tigecycline,vancomycin,linezolid,fourth-generation cephalosporins,carbapenems and aminoglycosides are more sensitive to MPF patients,while first-and second-generation cephalosporins and macrolides are more sensitive.The highest resistance rate.In the SPF group,tigecycline,third-and fourth-generation cephalosporins,aminoglycosides,carbapenems and compound penicillin had better effects.Compared with SPF,MPF was more likely to have infectious complications(83.7% vs 43.4%)and severe infection(18.4% vs 4.3%),and the duration of fever was longer.The incidence of intraperitoneal hemorrhage was 15.4% vs 7.5% in the MPF group compared with the SPF group.Most of the bleeding sites of MPF are intra-abdominal small blood vessels and gastrointestinal anastomotic ulcers,but gastroduodenal artery(GDA),common hepatic artery,inferior pancreaticoduodenal artery and pancreaticojejunostomy corrosive bleeding had a clear association with re-surgery and clinical death.Most of the bleeding sites in the SPF group were inaccurate,and non-surgical treatments such as continuous irrigation and negative pressure suction could effectively deal with them.Early jejunal nutrition combined with acupuncture therapy has a good effect on delayed gastric emptying,and all patients with intestinal fistula require secondary surgical intervention.ConclusionsThis study has shown that although the incidence of SPF is high,MPF is more likely to induce B/C grade pancreatic fistula and serious postoperative complications.For intestinal bacteria such as Enterococcus and Enterobacter,the MPF group is recommended to use fourth-generation cephalosporins for preventive medication,and in severe cases,carbapenems are recommended.Pseudomonas aeruginosa and Klebsiella pneumoniae were more common in the SPF group,and it is recommended to use third-and fourth-generation cephalosporins,compound penicillins or aminoglycosides.MPF bleeding requires early identification of the bleeding site and consideration of surgical intervention.Patients with delayed gastric emptying can receive early implantation of jejunal nutrition combined with acupuncture.If there is no effective drainage in patients with intestinal fistula,emergency surgery should be considered.