Clinical observation and analysis of modified pancreaticojejunostomy on pancreatic fistula after pancreaticoduodenectomy

Abstract

Objective To observe the clinical outcome of modified pancreaticojejunostomy after pancreaticoduodenectomy (PD) and to analyze the influencing factors of pancreatic fistula. Methods The clinical data of 62 patients with PD in our hospital from January 2014 to June 2018 were analyzed retrospectively. Twenty-seven patients were divided into the modified group, who were treated with horizontal plate-bound anastomosis, while 35 patients were divided into the traditional group, who were treated with hanging-thread anastomosis. The data were analyzed by using SPSS 15.0 software. The incidence of complications were expressed as n(%), and X2 test were used for analysis. Measurement data during the operation were expressed as mean±standard deviation, and were examined by independent t-test. Univariate analysis was performed by χ2 test or Fisher exact probability method, and multifactor analysis by using Logistic regression. A P value <0.05 was considered as significant difference. Results The operative time and hospitalization time in the modified group were significantly different from those in the traditional group (P<0.05). Pancreatic morbidity of 7.41% in modified group was significantly lower than 34.29% in traditional group, with significant difference (P<0.05). By using univariate analysis, it was found that location of lesion (duodenum), diameter of pancreatic duct (≤ 3 mm), the soft texture of pancreas and the anastomosis of pancreaticojejunostomy were the risk factors of pancreatic fistula after pancreatoduodenectomy (P<0.05). The diameter of pancreatic duct (<3 mm) and the location of lesion (duodenum) were found to be the risk factors of pancreatic fistula after pancreaticoduodenectomy by Logistic multivariate analysis (P<0.05). Conclusion The modified pancreaticointestinal anastomosis could effectively reduce the incidence of pancreatic fistula and could shorten the time of operation and hospitalization after PD. Key words: Pancreatic fistula; Pancreaticoduodenectomy; Pancreaticojejunostomy; Comparative study