[Application of pancreaticojejunostomy procedures selection strategy in pancreaticoduodenectomy and risk factors analysis of pancreatic fistula after operation].
OBJECTIVE
To evaluate the pancreaticojejunostomy procedures selection strategy in pancreaticoduodenectomy and to analyze risk factors of pancreatic fistula.


METHODS
Clinical data of 352 patients who received pancreaticoduodenectomy from September 2009 to September 2012 were retrospectively analyzed. For patients with soft pancreas, binding pancreaticojejunostomy was applied to 153 patients. For patients with hard pancreas, duct-to-mucosa pancreaticojejunostomy (DMPJ) was applied (199 cases). The clinical efficacy and incidence of postoperative complications were compared among 2 groups. Risk factors of pancreatic fistula were screened out from many factors by univariate and multivariate analysis.


RESULTS
The overall incidence of pancreatic leakage was 13.9% (49/352). There were no significant difference in incidences of pancreatic leakage (χ(2) = 0.512), peritoneal bleeding (χ(2) = 0.784), abdominal infection (χ(2) = 1.161), digestive dysfunction rate (χ(2) = 4.753) and mean duration of hospital stay (t = 2.13) among 2 groups (all P > 0.05). The results of multivariate analysis showed pancreatic tube diameter < 3 mm (OR = 5.748), preoperative total bilirubin level > 171 µmol/L (OR = 5.112), duration of preoperative jaundice > 8 weeks (OR = 5.090), preoperative albumin level < 30 g/L (OR = 4.464) were independent risk factors of pancreatic fistula (all P < 0.05).


CONCLUSIONS
Bunding pancreatojejunostomy was as good as soft pancreatic; for duct diameter ≥ 3 mm suggested using duct-to-mucosa pancreaticojejunostomy. For the risk factors for pancreatic leakage actively cooperate with preoperative nutritional support and timely treatment of jaundice, the incidence of postoperative pancreatic leakage will be further reduced.
Department of Surgery, Shanghai Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai 200127, China.
Wei
W
Liu
Department of Surgery, Shanghai Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai 200127, China.
Rong
R
Hua
Department of Surgery, Shanghai Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai 200127, China. Email: syw0616@126.com.
Yongwei
Y
Sun
Department of Surgery, Shanghai Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai 200127, China.
Junfeng
J
Zhang
Department of Surgery, Shanghai Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai 200127, China.
Yanmiao
Y
Huo
Department of Surgery, Shanghai Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai 200127, China.
Dejun
D
Liu
Department of Surgery, Shanghai Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai 200127, China.
Zhiyong
Z
Wu
Department of Surgery, Shanghai Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai 200127, China.
Weijin
W
Shi
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010185:Pancreatic Fistula; D016577:Pancreaticoduodenectomy; D010193:Pancreaticojejunostomy / Q000379:methods*; D011183:Postoperative Complications; D012189:Retrospective Studies; D012307:Risk Factors