Lesurtel Mickael, Dehni Nidal, Tiret Emmanuel, Parc Rolland, Paye François
Department of Digestive Surgery, Saint Antoine University-Hospital, 184 Rue du Faubourg Saint Antoine, 75012 Paris, France.
J Gastrointest Surg. 2006 Feb;10(2):286-91. doi: 10.1016/j.gassur.2005.05.011.
This study aimed to reappraise short-term and long-term results of palliative biliary and gastric bypass surgery in patients with unresectable pancreatic head carcinoma found at explorative laparotomy. We retrospectively analyzed 83 consecutive patients whose pancreatic head carcinoma appeared unresectable at laparotomy (vascular involvement [57%], liver metastases [24%], distant metastatic lymph nodes [11%], peritoneal implants [8%]) and who underwent palliative surgical concomitant biliary and gastric bypass. Postoperative mortality and morbidity rates were 4.8% and 26.5%, respectively. Postoperative-delayed gastric emptying occurred in 9 patients (10%). Antecolic (46%) and retrocolic (54%) gastrojejunostomies did not differ for the duration of nasogastric suction, the delay of oral intake, and the incidence of delayed gastric emptying. Mean hospital stay was 16 +/- 8 days. Median survival was 9 months (range 1-44). Late cholangitis occurred in 2 patients (2.4%) treated medically. One recurrent jaundice required transhepatic stenting 9 months from surgery. Four late gastric outlet obstructions occurred (4.8%) with a mean delay of 8 months from surgery. These data demonstrate that, in patients with unresectable pancreatic head carcinoma at laparotomy, palliative concomitant biliary and gastric bypass in a single procedure is safe and long-term efficient. This strategy remains to be compared to endoscopic palliation in this setting.
本研究旨在重新评估在剖腹探查术中发现的不可切除胰头癌患者行姑息性胆肠和胃肠吻合术的短期和长期结果。我们回顾性分析了83例连续患者，这些患者在剖腹手术中胰头癌表现为不可切除（血管受累[57%]、肝转移[24%]、远处转移性淋巴结[11%]、腹膜种植转移[8%]），并接受了姑息性手术同时行胆肠和胃肠吻合术。术后死亡率和发病率分别为4.8%和26.5%。9例患者（10%）发生术后胃排空延迟。结肠前（46%）和结肠后（54%）胃空肠吻合术在鼻胃管吸引时间、经口进食延迟和胃排空延迟发生率方面无差异。平均住院时间为16±8天。中位生存期为9个月（范围1 - 44个月）。2例患者（2.4%）发生迟发性胆管炎，经药物治疗。1例复发性黄疸在术后9个月需要行经肝支架置入术。发生4例晚期胃出口梗阻（4.8%），平均延迟时间为术后8个月。这些数据表明，对于剖腹手术中不可切除的胰头癌患者，单次姑息性同时行胆肠和胃肠吻合术是安全且长期有效的。在这种情况下，该策略仍有待与内镜下姑息治疗进行比较。
