Abstract:Objective：To investigate the risk factors and management of pancreatic fistula(PF) after pancreaticoduodenectomy（PD）. Methods：Two hundred and eighteen patients who underwent PD consecutively at our hospital from February 1994 to December 2005 were reviewed retrospectively. The management and outcomes of patients with PF were also evaluated. Sixteen factors which potentially affect the incidence of PF were analyzed with univariate and multivariate logistic regression model. Results：Of the 218 patients, the overall morbidity and hospital mortality were 29.8%（65/218）and 4.1%（9/218）respectively, and PE occurred in 30 patients(13.8%). PE was account for 46.1% in the overall morbidity. Of the 30 patients with PE, 25 had successful management conservatively with effective drainage including under B-ultrasonography guided or CT-guided percutaneous drainage. In the other 5 patients who had intra-abdominal abscess, two patients refused reoperation died of multiple organ failure, and one died of combination of intra-abdominal massive hemorrhage; the other two underwent reoperation for wide drainage, one survived, another died. The mortality of PF was 13.3%(4/30), which was account for 44.4% of overall mortality. Patients with PF had significantly higher morbidity（P＜0.01）and in-hospital mortality（P＜0.05）than those without PF. In univariate analysis, texture of the remnant pancreas, pancreatic duct size, drainage of pancreatic duct, duration of operation，perioperative nutrition support and use of prophylactic somatostatin analogues were related to occurrence of PF. Multivariate logistic regression analysis revealed that normal texture of the remnant pancreas and pancreatic duct size(≤3mm) were independent risk factors(OR=9.394 and 4.232). Conclusions：Pancreatic duct size and texture of the remnant pancreas are the independent risk factors of occurrence of PF after PD. If the optimal pancreatojejunal anastomotic technique is selected according to pancreatic duct size, texture of the remnant pancreas and experience of the surgeon, the incidence of PF can be reduced effectively. Early diagnosis and management of PE and other severe complications associated with PF are important to improve its outcome.