Clinical characteristics and influencing factors of patients with grade C pancreatic fistula after laparoscopic pancreaticoduodenectomy

doi:10.3877/cma.j.issn.1674-3946.2024.06.022

Abstract

Abstract:

Objective

To analyze the clinical features and influencing factors of grade C pancreatic fistula after laparoscopic pancreaticoduodenectomy (LPD).

Methods

Data of 265 patients with LPD from January 2020 to December 2023 were retrospectively analyzed. A total of 76 patients (28.7%) developed postoperative complications, and were divided into Grade C pancreatic fistula group (n=17 cases) and non-grade C pancreatic fistula group (n=59 cases) according to the occurrence of postoperative grade C pancreatic fistula. To analyze the clinical features of patients with grade C pancreatic fistula after LPD. Statistical software SPSS 26.0 was used for statistical analysis. Multivariate Logistic regression was used to analyze the factors affecting the occurrence of Grade C pancreatic fistula after LPD. P<0.05 was statistically significant.

Results

All 265 patients successfully completed LPD, including 8 cases (3.0%) of biochemical leakage, 19 cases (7.2%) of B-grade pancreatic fistula, 17 cases (6.4%) of C-grade pancreatic fistula, and 45 cases (17.0%) of other complications. There were statistically significant differences in age, BMI, pancreatic CT value, pancreatic duct diameter, pancreatic bowel reconstruction mode, ASA grade, intraoperative blood loss, and preoperative and postoperative PTA between grade C pancreatic fistula group and non-grade C pancreatic fistula group (P<0.05). Multivariate analysis showed that CT value of pancreas ≤40Hu, CT pancreatic duct diameter ≤2mm, and postoperative PTA≤75% were independent risk factors for C-grade pancreatic fistula after LPD (P<0.05), and reconstruction of main pancreatic duct jejunal bridge intraductal drainage in pancreatic enterostomy was protective factor for C-grade pancreatic fistula (P<0.05).

Conclusion

CT value of pancreas ≤40Hu, CT pancreatic duct diameter ≤2mm, and postoperative PTA≤75% are independent risk factors for C-grade pancreatic fistula after LPD, and the reconstruction of main pancreatic duct and jejunal bridge intraductal drainage in pancreatic enterostomy is a protective factor for C-grade pancreatic fistula.

Key words: Pancreaticoduodenectomy, Pancreatic Fistula, Clinical Features, Influencing Factor

Chao Zhang, Zhen Zhang, Liang Ma, Huanhuan Mu, Cailing Liu. Clinical characteristics and influencing factors of patients with grade C pancreatic fistula after laparoscopic pancreaticoduodenectomy[J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2024, 18(06): 675-678.

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Figures/Tables 2

References 16

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临床特征		C级胰瘘组（n=17）	非C级胰瘘组（n=59）	t/χ²值	P值
年龄（岁，）		66.9±5.8	63.3±6.4	2.084	0.041
性别（例）	男/女	11/6	43/16	0.429	0.513
BMI（kg/m²，）		24.1±2.6	22.3±3.4	2.016	0.047
高血压（例）	有/无	6/11	24/35	0.160	0.689
糖尿病（例）	有/无	7/10	15/44	0.918	0.338
冠心病（例）	有/无	4/13	23/36	1.376	0.241
吸烟（例）	有/无	10/7	36/23	0.027	0.871
饮酒（例）	有/无	9/8	29/30	0.076	0.783
术前减黄（例）	有/无	3/14	15/44	0.442	0.506
胆总管直径（mm，）		1.9±0.4	1.8±0.5	0.757	0.452
胰管直径（mm，例）	≤2/>2	13/4	11/48	8.014	0.005
胰腺CT值（Hu，例）	≤40/>40	14/3	28/31	6.500	0.011
手术时间（min，）		329.8±69.2	312.5±48.6	1.170	0.246
术中出血量（ml，）		251.2±28.4	238.7±23.5	1.843	0.069
术中输血（例）	有/无	6/11	23/36	0.076	0.783
ASA分级（例）	≥Ⅲ级/<Ⅲ级	13/4	24/35	6.768	0.009
肿瘤位置（例）	A/B/C/D	8/5/1/3	31/19/2/7	0.653	0.884
肿瘤直径（cm，）		3.1±0.6	3.3±0.4	1.612	0.111
胰肠重建方式（例）	E/F/G	1/6/10	27/24/8	17.211	0.000
术前TBil（μmol/L，例）	≤22.0/>22.0	7/10	35/24	1.758	0.185
术前PTA（%，例）	≤75/>75	5/12	5/54	5.063	0.023
术后PTA（%，例）	≤75/>75	10/7	16/43	5.894	0.015

临床特征		C级胰瘘组（n=17）	非C级胰瘘组（n=59）	t/χ²值	P值
年龄（岁，）		66.9±5.8	63.3±6.4	2.084	0.041
性别（例）	男/女	11/6	43/16	0.429	0.513
BMI（kg/m²，）		24.1±2.6	22.3±3.4	2.016	0.047
高血压（例）	有/无	6/11	24/35	0.160	0.689
糖尿病（例）	有/无	7/10	15/44	0.918	0.338
冠心病（例）	有/无	4/13	23/36	1.376	0.241
吸烟（例）	有/无	10/7	36/23	0.027	0.871
饮酒（例）	有/无	9/8	29/30	0.076	0.783
术前减黄（例）	有/无	3/14	15/44	0.442	0.506
胆总管直径（mm，）		1.9±0.4	1.8±0.5	0.757	0.452
胰管直径（mm，例）	≤2/>2	13/4	11/48	8.014	0.005
胰腺CT值（Hu，例）	≤40/>40	14/3	28/31	6.500	0.011
手术时间（min，）		329.8±69.2	312.5±48.6	1.170	0.246
术中出血量（ml，）		251.2±28.4	238.7±23.5	1.843	0.069
术中输血（例）	有/无	6/11	23/36	0.076	0.783
ASA分级（例）	≥Ⅲ级/<Ⅲ级	13/4	24/35	6.768	0.009
肿瘤位置（例）	A/B/C/D	8/5/1/3	31/19/2/7	0.653	0.884
肿瘤直径（cm，）		3.1±0.6	3.3±0.4	1.612	0.111
胰肠重建方式（例）	E/F/G	1/6/10	27/24/8	17.211	0.000
术前TBil（μmol/L，例）	≤22.0/>22.0	7/10	35/24	1.758	0.185
术前PTA（%，例）	≤75/>75	5/12	5/54	5.063	0.023
术后PTA（%，例）	≤75/>75	10/7	16/43	5.894	0.015

影响因素	回归系数（B）	Wald值	OR（95%CI）	P值
年龄	1.448	2.704	1.267（0.759~1.614）	0.098
BMI（kg/m²）	0.144	1.841	1.155（0.713~1.409）	0.147
胰腺CT值	0.921	5.916	1.864（1.411~2.369）	0.016
胰管直径	1.156	6.144	2.016（1.623~2.617）	0.011
胰肠重建方式	-1.573	4.972	0.614（0.249~0.905）	0.023
ASA分级	1.282	2.167	1.194（0.764~1.591）	0.071
术中出血量	1.364	2.967	1.410（0.913~1.764）	0.064
术前PTA	1.097	2.093	1.348（0.846~1.649）	0.105
术后PTA	0.846	4.268	1.697（1.107~1.938）	0.027

影响因素	回归系数（B）	Wald值	OR（95%CI）	P值
年龄	1.448	2.704	1.267（0.759~1.614）	0.098
BMI（kg/m²）	0.144	1.841	1.155（0.713~1.409）	0.147
胰腺CT值	0.921	5.916	1.864（1.411~2.369）	0.016
胰管直径	1.156	6.144	2.016（1.623~2.617）	0.011
胰肠重建方式	-1.573	4.972	0.614（0.249~0.905）	0.023
ASA分级	1.282	2.167	1.194（0.764~1.591）	0.071
术中出血量	1.364	2.967	1.410（0.913~1.764）	0.064
术前PTA	1.097	2.093	1.348（0.846~1.649）	0.105
术后PTA	0.846	4.268	1.697（1.107~1.938）	0.027

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