Hamade A M, Al-Bahrani A Z, Owera A M A, Hamoodi A A, Abid G H, Bani Hani O I, O'Shea S, Lee S H, Ammori B J
Department of Surgery, Manchester Royal Infirmary, M13 9WL, Manchester, UK.
Surg Endosc. 2005 Oct;19(10):1333-40. doi: 10.1007/s00464-004-2282-4. Epub 2005 Jul 21.
Laparoscopic bypass surgery for the palliation of gastric and biliary obstruction is associated with a rapid recovery. This study aimed to extend its application to other aspects in the management of patients with periampullary cancer.
Between 2001 and 2004, 21 patients (median age, 68 years) underwent laparoscopic gastric (n = 8), biliary (n = 5), and combined gastric and biliary (n = 8) bypass. In addition to its therapeutic role (n = 12), indications included a concomitant prophylactic gastric (n = 3) and biliary (n = 2) bypass as well as pre- 1 Whipple's relief of deep jaundice at the time of staging laparoscopy (n = 3). Construction of the biliary bypass to the gallbladder (n = 11) or bile duct (n = 2) was based on preoperative imaging.
All procedures were completed laparoscopically. The median operating times for gastric, biliary, and combined bypass were 75, 60, and 130 min, respectively. The addition of a prophylactic bypass did not significantly prolong the operating time, as compared with a single therapeutic bypass. One patient died postoperatively of aspiration pneumonia. The postoperative hospital stay (median, 4 days) was not significantly influenced by the type of bypass. No recurrence of or new obstructive symptoms developed during the follow-up period after a therapeutic or prophylactic bypass.
Applications of laparoscopic gastric and biliary bypass can safely be expanded to include a prophylactic role and preresection relief of obstructive jaundice. Prophylactic bypass surgery does not prolong operating time or hospital stay significantly and prevents future onset of obstructive symptoms.
腹腔镜旁路手术用于缓解胃和胆道梗阻，患者恢复迅速。本研究旨在将其应用扩展至壶腹周围癌患者管理的其他方面。
2001年至2004年间，21例患者（中位年龄68岁）接受了腹腔镜胃旁路手术（n = 8）、胆道旁路手术（n = 5）以及胃和胆道联合旁路手术（n = 8）。除了其治疗作用（n = 12）外，手术指征还包括预防性胃旁路手术（n = 3）和胆道旁路手术（n = 2），以及在分期腹腔镜检查时进行术前Whipple手术以缓解深度黄疸（n = 3）。基于术前影像学检查，将胆道旁路构建至胆囊（n = 11）或胆管（n = 2）。
所有手术均通过腹腔镜完成。胃旁路、胆道旁路和联合旁路的中位手术时间分别为75分钟、60分钟和130分钟。与单一治疗性旁路手术相比，增加预防性旁路手术并未显著延长手术时间。1例患者术后死于吸入性肺炎。术后住院时间（中位值为4天）未受旁路手术类型的显著影响。在治疗性或预防性旁路手术后的随访期间，未出现梗阻症状复发或新的梗阻症状。
腹腔镜胃和胆道旁路手术的应用可以安全地扩展至包括预防性作用以及术前切除缓解梗阻性黄疸。预防性旁路手术不会显著延长手术时间或住院时间，并可预防未来梗阻症状的发生。
