结肠前重建对保留幽门胰十二指肠切除术后胃排空延迟的影响。
Effect of antecolic reconstruction on delayed gastric emptying after the pylorus-preserving Whipple procedure.
作者信息
Hartel Mark, Wente Moritz N, Hinz Ulf, Kleeff Jörg, Wagner Markus, Müller Michael W, Friess Helmut, Büchler Markus W
机构信息
Department of General Surgery, University of Heidelberg, Heidelberg, Germany.
出版信息
Arch Surg. 2005 Nov;140(11):1094-9. doi: 10.1001/archsurg.140.11.1094.
HYPOTHESIS
Antecolic duodenojejunostomy prevents delayed gastric emptying (DGE) after a pylorus-preserving Whipple (ppW) procedure better than retrocolic duodenojejunostomy.
DESIGN
A single operation team's experience with antecolic and retrocolic duodenojejunostomy in ppW is analyzed on a prospective database using univariate and multivariate models.
SETTING
Tertiary referral center that focuses on pancreatic diseases.
PATIENTS AND INTERVENTIONS
One hundred consecutive patients undergoing a ppW procedure with retrocolic reconstruction between January 1, 1996, and December 31, 2001, and 100 consecutive patients undergoing a ppW procedure with antecolic reconstruction between January 1, 2002, and December 31, 2003. Characteristics such as median age, median hospital stay, sex, diagnosis, previous operations, blood loss, surgical and medical complications, American Society of Anesthesiologists risk groups, stent implantation, and especially DGE were matched for the comparison groups.
MAIN OUTCOME MEASURES
We compared DGE, characteristics, and perioperative variables in patients with antecolic vs retrocolic reconstruction after ppW.
RESULTS
The DGE occurred significantly more often in patients with retrocolic reconstruction than in those with antecolic reconstruction (P < .001). The antecolic and retrocolic study groups were comparable in age (P = .25), sex (P = .48), and postoperative surgical (P = .19) and medical (P = .054) complications. The univariate analysis between patients with and without DGE did not show significant differences regarding diagnosis, previous operations, blood loss, surgical and medical complications, American Society of Anesthesiologists classification, or stent implantation. In the multivariate analysis, only the type of reconstruction (P = .006) and sex (P = .04) seemed to affect DGE.
CONCLUSION
We recommend antecolic duodenjejunostomy in patients undergoing a ppW procedure regardless of their diagnosis.
假设
在保留幽门的胰十二指肠切除术（ppW）后，结肠前十二指肠空肠吻合术比结肠后十二指肠空肠吻合术更能预防胃排空延迟（DGE）。
设计
使用单变量和多变量模型，在一个前瞻性数据库中分析了一个手术团队在ppW中进行结肠前和结肠后十二指肠空肠吻合术的经验。
地点
专注于胰腺疾病的三级转诊中心。
患者和干预措施
1996年1月1日至2001年12月31日期间连续100例接受ppW手术并进行结肠后重建的患者，以及2002年1月1日至2003年12月31日期间连续100例接受ppW手术并进行结肠前重建的患者。对比较组的年龄中位数、住院时间中位数、性别、诊断、既往手术、失血量、手术和医疗并发症、美国麻醉医师协会风险分组、支架植入情况，尤其是DGE等特征进行匹配。
主要观察指标
我们比较了ppW术后结肠前重建与结肠后重建患者的DGE、特征和围手术期变量。
结果
结肠后重建患者发生DGE的频率明显高于结肠前重建患者（P <.001）。结肠前和结肠后研究组在年龄（P =.25）、性别（P =.48）以及术后手术（P =.19）和医疗（P =.054）并发症方面具有可比性。有或无DGE患者之间的单变量分析在诊断、既往手术、失血量、手术和医疗并发症、美国麻醉医师协会分类或支架植入方面未显示出显著差异。在多变量分析中，似乎只有重建类型（P =.006）和性别（P =.04）会影响DGE。
结论
我们建议无论诊断如何，接受ppW手术的患者均采用结肠前十二指肠空肠吻合术。
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