Zhang Shiwei, Yadav Dipesh Kumar, Wang Gaoqing, Jiang Yin, Zhang Jie, Yadav Rajesh Kumar, Singh Alina, Gao Guo, Chen Junyu, Mao Yefan, Wang Chengwei, Meng Yudi, Hua Yongfei
Department of Hepatobiliary and Pancreatic Surgery, Ningbo Medical Center Lihuili Hospital, Ningbo University, Ningbo, Zhejiang, China.
Department of General Surgery, Wenzhou People's Hospital, The Third Clinical Institute Affiliated to Wenzhou Medical University, The Third Affiliated Hospital of Shanghai University, Wenzhou, China.
Front Oncol. 2024 Aug 23;14:1464450. doi: 10.3389/fonc.2024.1464450. eCollection 2024.
To delineate the risk factors and causes of unplanned reoperations within 30 days following laparoscopic pancreaticoduodenectomy (LPD).
A retrospective study reviewed 311 LPD patients at Ningbo Medical Center Li Huili Hospital from 2017 to 2024. Demographic and clinical parameters were analyzed using univariate and multivariate analyses, with P < 0.05 indicating statistical significance.
Out of 311 patients, 23 (7.4%) required unplanned reoperations within 30 days post-LPD, primarily due to postoperative bleeding (82.6%). Other causes included anastomotic leakage, abdominal infection, and afferent loop obstruction. The reoperation intervals varied, with the majority occurring within 0 to 14 days post-surgery. Univariate analysis identified significant risk factors: diabetes, liver cirrhosis, elevated CRP on POD-3 and POD-7, pre-operative serum prealbumin < 0.15 g/L, prolonged operation time, intraoperative bleeding > 120 ml, vascular reconstruction, soft pancreatic texture, and a main pancreatic duct diameter ≤3 mm (all P < 0.05). Multivariate analysis confirmed independent risk factors: pre-operative serum prealbumin < 0.15 g/L (OR = 3.519, 95% CI 1.167-10.613), CRP on POD-7 (OR = 1.013, 95% CI 1.001-1.026), vascular reconstruction (OR = 9.897, 95% CI 2.405-40.733), soft pancreatic texture (OR = 5.243, 95% CI 1.628-16.885), and a main pancreatic duct diameter ≤3 mm (OR = 3.462, 95% CI 1.049-11.423), all associated with unplanned reoperation within 30 days post-LPD (all P < 0.05).
Postoperative bleeding is the primary cause of unplanned reoperations after LPD. Independent risk factors, confirmed by multivariate analysis, include low pre-operative serum prealbumin, elevated CRP on POD-7, vascular reconstruction, soft pancreatic texture, and a main pancreatic duct diameter of ≤3 mm. Comprehensive peri-operative management focusing on these risk factors can reduce the likelihood of unplanned reoperations and improve patient outcomes.
明确腹腔镜胰十二指肠切除术（LPD）后30天内计划外再次手术的危险因素及原因。
一项回顾性研究对2017年至2024年在宁波市医疗中心李惠利医院接受LPD的311例患者进行了分析。采用单因素和多因素分析方法对人口统计学和临床参数进行分析，P<0.05表示具有统计学意义。
311例患者中，23例（7.4%）在LPD术后30天内需要进行计划外再次手术，主要原因是术后出血（82.6%）。其他原因包括吻合口漏、腹腔感染和输入袢梗阻。再次手术间隔时间各不相同，大多数发生在术后0至14天内。单因素分析确定了显著的危险因素：糖尿病、肝硬化、术后第3天和第7天CRP升高、术前血清前白蛋白<0.15g/L、手术时间延长、术中出血>120ml、血管重建、胰腺质地柔软以及主胰管直径≤3mm（所有P<0.05）。多因素分析证实了独立危险因素：术前血清前白蛋白<0.15g/L（OR=3.519，95%CI 1.167-10.613）、术后第7天CRP（OR=1.013，95%CI 1.001-1.026）、血管重建（OR=9.897，95%CI 2.405-40.733）、胰腺质地柔软（OR=5.243，95%CI 1.628-16.885）以及主胰管直径≤3mm（OR=3.462，95%CI 1.049-11.423），所有这些均与LPD术后30天内计划外再次手术相关（所有P<0.05）。
术后出血是LPD后计划外再次手术的主要原因。多因素分析证实的独立危险因素包括术前血清前白蛋白水平低、术后第7天CRP升高、血管重建、胰腺质地柔软以及主胰管直径≤3mm。针对这些危险因素进行全面的围手术期管理可以降低计划外再次手术的可能性并改善患者预后。
