Machado M C, Cunha J E, Penteado S, Jukemura J, Herman P, Bacchella T
Department of Gastroenterology, São Paulo University Medical School, São Paulo, Brazil.
Hepatogastroenterology. 2000 Nov-Dec;47(36):1741-3.
BACKGROUND/AIMS: Most of the patients with pancreatic cancer can be only palliatively treated. Although 30% of the patients submitted to palliative biliary bypass will require further treatment for duodenal obstruction, prophylactic gastric bypass still remains a controversial issue in the management of unresectable pancreatic head carcinoma. The main disadvantage of current techniques of gastrojejunostomy is postoperative vomiting due to impaired gastric motility and circulus vitiosus through the nonobstructed duodenum. A new technique of prophylactic gastrojejunostomy is described herein as an attempt to obviate these complications.
An antecolic isoperistaltic gastrojejunostomy was fashioned at the gastric mid-body above the angulus. The afferent limb was partitioned close to the gastrojejunostomy and a Braun type entero-enterostomy constructed joining the afferent and the efferent limbs. Following the gastrojejunostomy a Roux-en-Y choledochojejunostomy was performed.
In 19 patients consecutively submitted to this procedure no postoperative mortality or complications occurred. Nasogastric suction was interrupted at postoperative day 3 and oral feeding resumed on the next day. Neither early nor late postoperative vomiting was observed.
These encouraging preliminary results suggest that this procedure may have its place in the palliative treatment of pancreatic head carcinoma.
背景/目的：大多数胰腺癌患者只能接受姑息治疗。尽管30%接受姑息性胆肠吻合术的患者需要进一步治疗十二指肠梗阻，但预防性胃旁路手术在不可切除的胰头癌治疗中仍然是一个有争议的问题。目前胃空肠吻合术技术的主要缺点是由于胃动力受损和通过无梗阻十二指肠的恶性循环导致术后呕吐。本文描述了一种预防性胃空肠吻合术的新技术，试图避免这些并发症。
在胃角上方的胃体中部进行结肠前顺蠕动胃空肠吻合术。在靠近胃空肠吻合处将输入袢分开，并构建一个布朗式肠肠吻合术连接输入袢和输出袢。在胃空肠吻合术后进行 Roux-en-Y 胆总管空肠吻合术。
连续19例接受该手术的患者未发生术后死亡或并发症。术后第3天停止胃肠减压，次日恢复经口进食。未观察到术后早期或晚期呕吐。
这些令人鼓舞的初步结果表明，该手术可能在胰头癌的姑息治疗中占有一席之地。
