Aranha Gerard V, Hodul Pamela J, Creech Steven, Jacobs William
Section of Surgical Oncology, Hines VA Hospital, Maywood, IL 60153, USA.
J Am Coll Surg. 2003 Aug;197(2):223-31; discussion 231-2. doi: 10.1016/S1072-7515(03)00331-4.
Since 1968, there have been three published reports in the United States literature of 41, 118, and 145 consecutive patients undergoing pancreaticoduodenectomy without mortality. In all of these series, the pancreatic remnant was anastomosed to the jejunum.
This study was designed to review 152 consecutive patients who underwent pancreaticoduodenectomy in whom the pancreatic remnant was anastomosed to the stomach (pancreaticogastrostomy).
A total of 152 patients underwent pancreaticoduodenectomy with pancreaticogastrostomy between July 1992 and May 2002. There were 85 men and 67 women with a mean age of 65.7 years (range 31 to 90 years). Of the patients, 87 were less than 69 years of age and 65 were more than 69 years. A total of 114 patients had a malignant neoplasm and the remaining 38 had either cystic neoplasms or benign disease. When the two groups were compared, the patients who were more than 69 years of age had a significantly high incidence of hypertension, previous cancer, atrial fibrillation, and coronary artery disease. In addition, patients more than 69 years of age had a significantly high incidence of jaundice and placement of preoperative stents. Patients more than 69 years of age had significantly less operative time but there was no between-group difference in estimated blood loss, transfusion, number of units transfused, and postoperative length of stay. There was no postoperative mortality [corrected] in this series. Pancreatic leak and fistulae were the most common complications, followed by intraabdominal abscess, wound infection, and delayed gastric emptying.
In this study, 152 consecutive patients underwent pancreaticoduodenectomy with pancreaticogastrostomy without postoperative mortality. Morbidity was mostly because of pancreatic leaks and fistulae, which were successfully treated nonoperatively. With proper selection, careful preoperative preparation, and proper intraoperative conduct of operation, the Whipple procedure can be performed without postoperative mortality.
自1968年以来，美国文献中已发表了三篇关于连续41例、118例和145例患者接受胰十二指肠切除术且无死亡病例的报告。在所有这些系列研究中，胰腺残端均与空肠吻合。
本研究旨在回顾152例连续接受胰十二指肠切除术且胰腺残端与胃吻合（胰胃吻合术）的患者。
1992年7月至2002年5月期间，共有152例患者接受了胰胃吻合的胰十二指肠切除术。其中男性85例，女性67例，平均年龄65.7岁（范围31至90岁）。患者中，87例年龄小于69岁，65例年龄大于69岁。共有114例患者患有恶性肿瘤，其余38例患有囊性肿瘤或良性疾病。两组比较时，年龄大于69岁的患者高血压、既往癌症、心房颤动和冠状动脉疾病的发生率显著较高。此外，年龄大于69岁的患者黄疸和术前放置支架的发生率也显著较高。年龄大于69岁的患者手术时间明显较短，但两组在估计失血量、输血、输血量和术后住院时间方面无差异。本系列研究无术后死亡[校正后]病例。胰漏和瘘是最常见的并发症，其次是腹腔内脓肿、伤口感染和胃排空延迟。
在本研究中，152例连续患者接受了胰胃吻合的胰十二指肠切除术，无术后死亡病例。发病率主要是由于胰漏和瘘，这些并发症通过非手术治疗成功治愈。通过适当的选择、仔细的术前准备和正确的术中操作，惠普尔手术可以在无术后死亡的情况下进行。
