Wang Ruobing, Jiang Peiqiang, Chen Qingmin, Liu Songyang, Jia Feng, Liu Yahui
Department of Hepatobiliary and Pancreatic Surgery, The First Hospital of Jilin University, Changchun, Jilin, China.
J Minim Access Surg. 2023 Jan-Mar;19(1):28-34. doi: 10.4103/jmas.jmas_336_21.
Pancreatic fistula (PF) and biliary fistula (BF) are two major leakage complications after pancreatoduodenectomy (PD). The aim of this study is to investigate the risk factors of PF and BF after laparoscopic PD (LPD).
We conducted a retrospective analysis of 500 patients who underwent LPD from 1 April 2015 to 31 March 2020. Clinical data from patients were analysed using multivariate logistic regression analysis.
PF occurred in 86 (17.2%) patients. Univariate and multivariate analysis indicated that the soft texture of the pancreas (P = 0.001) was the independent risk factor for PF. BF occurred in 32 (6.4%) patients. Univariate and multivariate analysis indicated that history of cardiovascular disease (P < 0.001), surgical time (P = 0.005), pre-operative CA125 (P = 0.036) and pre-operative total bilirubin (P = 0.044) were independent risk factors for BF.
The texture of the pancreas was an independent risk factor for PF after LPD, which was consistent with the literatures. In addition, history of cardiovascular disease, surgical time, pre-operative CA125 and pre-operative total bilirubin were new independent risk factors for BF after LPD. Therefore, patients with high-risk factors of BF should be informed that they are at a high risk for this complication.
胰瘘（PF）和胆瘘（BF）是胰十二指肠切除术（PD）后两种主要的渗漏并发症。本研究旨在探讨腹腔镜胰十二指肠切除术（LPD）后发生PF和BF的危险因素。
我们对2015年4月1日至2020年3月31日期间接受LPD的500例患者进行了回顾性分析。使用多因素逻辑回归分析对患者的临床资料进行分析。
86例（17.2%）患者发生PF。单因素和多因素分析表明，胰腺质地柔软（P = 0.001）是PF的独立危险因素。32例（6.4%）患者发生BF。单因素和多因素分析表明，心血管疾病史（P < 0.001）、手术时间（P = 0.005）、术前CA125（P = 0.036）和术前总胆红素（P = 0.044）是BF的独立危险因素。
胰腺质地是LPD后发生PF的独立危险因素，这与文献报道一致。此外，心血管疾病史、手术时间、术前CA125和术前总胆红素是LPD后发生BF的新的独立危险因素。因此，应告知具有BF高危因素的患者其发生该并发症的风险较高。
