Fernández-Cruz Laureano, Cosa Rebeca, Blanco Laia, López-Boado Miguel Angel, Astudillo Emiliano
ICMDM Department of Surgery, Hospital Clínic de Barcelona, Barcelona, Spain.
Ann Surg. 2008 Dec;248(6):930-8. doi: 10.1097/SLA.0b013e31818fefc7.
To compare the results of postoperative morbidity rate of a new pancreatogastrostomy technique, pylorus-preserving pancreaticoduodenectomy (PPPD) with gastric partition (PPPD-GP) with the conventional technique of pancreaticojejunostomy (PJ).
Pancreatojejunostomy and pancreatogastrostomy (PG) are the commonly preferred methods of anastomosis after pancreatoduodenectomy (PD). All randomized controlled trials failed to show advantage of a particular technique, suggesting that both PJ and PG provide equally results. However, postoperative morbidity remains high. The best technique in pancreatic anastomosis is still debated.
Described here is a new technique, PPPD-GP; in this technique the gastroepiploic arcade is preserved. Gastric partition was performed using 2 endo-Gia staplers along the greater curvature of the stomach, 3 cm from the border. This gastric segment, 10 to 12 cm in length is placed in close proximity to the cut edge of the pancreatic stump. An end-to-side, duct-to-mucosa anastomosis (with pancreatic duct stent) is constructed. One hundred eight patients undergoing PPPD for benign and malignant diseases of the pancreatic head and the periampullary region were randomized to receive PG (PPPD-GP) or end-to-side PJ (PPPD-PJ).
The two treatment groups showed no differences in preoperative parameters and intraoperative factors. The overall postoperative complications were 23% after PPPD-GP and 44% after PPPD-PJ (P < 0.01). The incidence of pancreatic fistula was 4% after PPPD-GP and 18% after PPPD-PJ (P < 0.01). The mean + SD hospital stay was 12 +/- 2 days after PPPD-GP and 16 +/- 3 days after PPPD-PJ.
This study shows that PPPD-GP can be performed safely and is associated with less complication than PPPD-PJ. The advantage of this technique over other PG techniques is that the anastomosis is outside the area of the stomach where the contents empty into the jejunum, but pancreatic juice drains directly into the stomach.
比较一种新的胰胃吻合技术——保留幽门的胰十二指肠切除术（PPPD）加胃分隔术（PPPD-GP）与传统胰肠吻合术（PJ）的术后发病率结果。
胰肠吻合术和胰胃吻合术（PG）是胰十二指肠切除术（PD）后常用的吻合方法。所有随机对照试验均未显示出特定技术的优势，这表明PJ和PG的效果相当。然而，术后发病率仍然很高。胰腺吻合的最佳技术仍存在争议。
本文描述了一种新技术，即PPPD-GP；在该技术中保留了胃网膜血管弓。使用2个内镜切割吻合器沿着胃大弯距边缘3 cm处进行胃分隔。这个长10至12 cm的胃段紧邻胰腺残端的切缘放置。构建端侧、胰管对黏膜的吻合（带有胰管支架）。108例因胰头和壶腹周围区域的良性和恶性疾病接受PPPD的患者被随机分为接受PG（PPPD-GP）或端侧PJ（PPPD-PJ）。
两个治疗组在术前参数和术中因素方面无差异。PPPD-GP术后总体并发症发生率为23%，PPPD-PJ术后为44%（P<0.01）。PPPD-GP术后胰瘘发生率为4%，PPPD-PJ术后为18%（P<0.01）。PPPD-GP术后平均住院时间为12±2天，PPPD-PJ术后为16±3天。
本研究表明，PPPD-GP可以安全实施，且与PPPD-PJ相比并发症更少。该技术相对于其他PG技术的优势在于，吻合位于胃内容物排入空肠区域之外，但胰液直接排入胃内。
