Le Blanc-Louvry I, Ducrotté P, Peillon C, Testart J, Denis P, Michot F, Tenière P
Digestive Tract Research Group, Rouen University Hospital, France.
J Am Coll Surg. 1999 Mar;188(3):261-70. doi: 10.1016/s1072-7515(98)00309-3.
The goal of this study was to compare upper jejunal motor patterns after Billroth II pancreatoduodenectomy according to the type of pancreatic anastomosis (pancreaticojejunostomy [PJA] or pancreaticogastrostomy [PGA]) and the presence or absence of postoperative symptoms.
Manometric recordings during fasting and after a 750-kcal meal were performed in the afferent limb in 12 patients (7 PJA, 5 PGA) and in the efferent limb in 15 other patients (7 PJA, 8 PGA) with a postoperative delay of 15+/-6 days and 3.9+/-2.2 months respectively. Patient data were compared to those of 20 healthy controls.
During fasting, the 2 main abnormal findings were a higher incidence (p < 0.05) and a slower migration velocity (p < 0.01) of incomplete phase III by comparison with that recorded in controls. No difference for phase III was observed between the 2 surgical procedures regardless of recording site. Trimebutine, 100 mg intravenously, induced a phase III in 89% (24 of 27) of the patients. Delay of motor response varied from 5 to 10 minutes without difference between the recording site; it was less than 2 minutes in 100% of controls. Trimebutine-induced phase III showed similar propagation abnormalities to the spontaneous phase III. Duration of the fed pattern (p < 0.001) and motor index (p < 0.001) were significantly lower than in controls after the meal, in both limbs, whatever the type of anastomosis. Differences between the 2 surgical procedures were a slower migration velocity of phase III (p < 0.01) and a lower postmeal motor index (p < 0.05) in the efferent limb after PJA than after PGA. Nine of 27 patients were symptomatic. In these 9 patients, mean phase III migration velocity was slower (p < 0.001), and mean area under the postprandial curve was higher (p < 0.01) than in asymptomatic patients. Propagated clusters of contractions were only found in symptomatic patients and in the afferent limb.
Pancreatoduodenectomy is associated with significant motor disturbances, mainly slower phase III and a reduced fed pattern, in the upper jejunum, at least during the first 3 postoperative months. Few motor differences were observed between PGA and PJA pancreatic anastomosis. A lesser occurrence of postsurgical motor anomalies does not appear to be an argument for preferring PGA to PJA.
本研究的目的是根据胰腺吻合类型（胰管空肠吻合术[PJA]或胰管胃吻合术[PGA]）以及术后症状的有无，比较毕Ⅱ式胰十二指肠切除术后上 jejunal 运动模式。
对 12 例患者（7 例 PJA，5 例 PGA）的输入袢进行空腹及进食 750 千卡餐后的测压记录，对另外 15 例患者（7 例 PJA，8 例 PGA）的输出袢进行测压记录，术后延迟时间分别为 15±6 天和 3.9±2.2 个月。将患者数据与 20 例健康对照者的数据进行比较。
空腹时，与对照组相比，2 个主要异常发现是不完全Ⅲ期的发生率更高（p<0.05）和迁移速度更慢（p<0.01）。无论记录部位如何，2 种手术方式之间Ⅲ期均未观察到差异。静脉注射曲美布汀 100mg，89%（27 例中的 24 例）患者诱发出Ⅲ期。运动反应延迟时间为 5 至 10 分钟，记录部位之间无差异；100%的对照组延迟时间小于 2 分钟。曲美布汀诱发的Ⅲ期显示出与自发Ⅲ期相似的传播异常。无论吻合类型如何，进食后 2 个肢体的进食模式持续时间（p<0.001）和运动指数（p<0.001）均显著低于对照组。2 种手术方式之间的差异在于，PJA 术后输出袢的Ⅲ期迁移速度较慢（p<0.01），进食后运动指数较低（p<0.05）。27 例患者中有 9 例有症状。在这 9 例患者中，平均Ⅲ期迁移速度较慢（p<0.001），餐后曲线下平均面积高于无症状患者（p<0.01）。仅在有症状患者和输入袢中发现了传播性收缩簇。
胰十二指肠切除术与上 jejunum 明显的运动障碍有关，主要是Ⅲ期较慢和进食模式减少，至少在术后前 3 个月。PGA 和 PJA 胰腺吻合术之间观察到的运动差异很少。术后运动异常发生率较低似乎不是优先选择 PGA 而非 PJA 的理由。
