Objective To explore the risk factors of pancreatic fistula after pancreatoduodenectomy(PD) in China,and provide a theoretical basis for reducing the incidence of postoperative pancreatic fistula.
Methods Meta-analysis was used in 33 papers on risk factors of the pancreatic fistula after pancreaticoduodenectomy published in China from June 2002 to June 2012.
Results There were no positive correlation between the incidence of pancreatic fistula after PD and the age and gender of patients,preoperative levels of albumin and hemoglobin,operation time,and the combination with diabetes,hypertension and coronary heart disease(
P＞0.05).The patient with high level of preoperative jaundice (higher than 171 μmol/L) were with higher incidence of pancreatic fistula after PD when compared with the patients with a preoperative jaundice level of less than 171 μmol/L(
P＜0.05),furthermore,the preoperative biliary drainage therapy might not decrease the incidence of pancreatic fistula after PD(
P＞0.05).The patients with pancreatic duct diameter greater than 3mm had lower incidence of pancreatic fistula than those with duct diameter less than 3 mm(
P＜0.05).The pancreatic duct drainage with stent decreased the incidence of pancreatic fistula after PD(
P＜0.05).The patients with the amount of bleeding during the operation more than 1 000 ml had a higher incidence of pancreatic fistula after PD(
P＜0.05).The postoperative somatostatin administration might decrease the incidence of pancreatic fistula after PD(
P＜0.05).The patients with a history of abdominal surgery had a higher rate of pancreatic leak than the control group after PD(
P＜0.05).
Conclusion The pancreatic fistula after PD does not positively correlated with gender and age of patients,preoperative levels of albumin and hemoglobin,operation time,and the combination with diabetes,hypertension and coronary heart disease.The preoperative severe jaundice,small pancreatic duct diameter,without the support of the pancreatic duct drainage,the amount of bleeding,unused somatostatin and operation on abdominal region are the risk factors of the pathogenesis of pancreatic fistula.
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