Risk factors for pancreatic fistula after pancreaticoduodenectomy

Objective To investigate the risk factors for pancreatic fistula after pancreaticoduodenectomy( PD),and to provide a reference for the prevention and treatment of pancreatic fistula after PD in clinical treatment. Methods A retrospective analysis was performed for the clinical data of 75 patients who underwent PD in Huadong Hospital,Fudan University from January 2014 to December 2015. The influencing factors for pancreatic fistula were analyzed,and the incidence rate of pancreatic fistula was compared between patients undergoing laparoscopic or open PD. The chi- square test or Fisher's exact test was used for univariate analysis,and the logistic regression model was used for multivariate analysis. Results Of all patients,21( 28%) had pancreatic fistula,among whom 7 had grade A pancreatic fistula,11 had grade B pancreatic fistula,and 3 had grade C pancreatic fistula. The univariate analysis showed that age,presence or absence of pancreatic duct dilatation,and amylase level in drainage fluid on day 1 after surgery were influencing factors for pancreatic fistula after surgery( χ2=6. 868,12. 990,and 4. 383,P = 0. 009,P < 0. 001,and P = 0. 004). The multivariate analysis showed that age ≥65 years( 95% CI:2. 551- 187. 550,P = 0. 005) and absence of pancreatic duct dilatation( 95% CI: 5. 210- 487. 321,P = 0. 001) were risk factors for pancreatic fistula after surgery. An amylase level of ≥5000 IU / L in drainage fluid on day 1 after surgery had a certain predictive value for the development of pancreatic fistula after surgery. There was no significant difference in the incidence rate of pancreatic fistula between patients undergoing laparoscopic or open PD( 18. 8% vs 30. 5%,P > 0. 05). Conclusion As for patients with an age of ≥65 years,absence of pancreatic duct dilatation,and an amylase level of ≥5000 IU / L in drainage fluid on day 1 after surgery,treatment should be given as soon as possible to avoid the development of pancreatic fistula.