Mack Lloyd A, Kaklamanos Ioannis G, Livingstone Alan S, Levi Joe U, Robinson Carolyn, Sleeman Danny, Franceschi Dido, Bathe Oliver F
Department of Surgery, University of Calgary, Calgary, Canada.
Ann Surg. 2004 Nov;240(5):845-51. doi: 10.1097/01.sla.0000143299.72623.73.
The objective of this study was to assess the feasibility and safety of inserting a double-lumen gastrojejunostomy tube (GJT) after pancreaticoduodenectomy (PD) and to evaluate associated outcomes.
Gastroparesis is a frequent postoperative event following PD. This often necessitates prolonged gastric decompression and nutritional support. A double-lumen GJT may be particularly useful in this situation: gastric decompression may be achieved through the gastric port without a nasogastric tube; enteral feeding may be administered through the jejunal port.
Thirty-six patients with periampullary tumors were randomized at the time of PD to insertion of GJT or to the routine care of the operating surgeon. Outcomes, including length of stay, complications, and costs, were followed prospectively.
The 2 groups had similar characteristics. Prolonged gastroparesis occurred in 4 controls (25%) and in none of the patients who had a GJT (P = 0.03). Complication rates were similar in each group. Mean postoperative length of stay was significantly longer in controls compared with patients who had a GJT (15.8 +/- 7.8 days versus 11.5 +/- 2.9 days, respectively; P = 0.01). Hospital charges were 82,151 +/- 56,632 dollars in controls and 52,589 +/- 15,964 dollars in the GJT group (P = 0.036).
In patients undergoing PD, insertion of a GJT is safe. Moreover, insertion of a GJT improves average length of stay. At the time of resection of periampullary tumors, GJT insertion should be considered, especially given this is a patient population in which weight loss and cachexia are frequent.
本研究的目的是评估胰十二指肠切除术(PD)后插入双腔胃肠造口术管(GJT)的可行性和安全性,并评估相关结果。
胃轻瘫是PD术后常见的事件。这通常需要延长胃减压和营养支持。在这种情况下,双腔GJT可能特别有用:可通过胃端口实现胃减压而无需鼻胃管;可通过空肠端口进行肠内喂养。
36例壶腹周围肿瘤患者在PD时随机分为插入GJT组或接受手术医生的常规护理组。前瞻性地跟踪包括住院时间、并发症和费用在内的结果。
两组具有相似的特征。4例对照组患者(25%)发生了持续性胃轻瘫,而GJT组患者均未发生(P = 0.03)。每组的并发症发生率相似。与GJT组患者相比,对照组患者的术后平均住院时间明显更长(分别为15.8±7.8天和11.5±2.9天;P = 0.01)。对照组的住院费用为82,151±56,632美元,GJT组为52,589±15,964美元(P = 0.036)。
在接受PD的患者中,插入GJT是安全的。此外,插入GJT可缩短平均住院时间。在切除壶腹周围肿瘤时,应考虑插入GJT,特别是鉴于这是一个经常出现体重减轻和恶病质的患者群体。