Tani Masaji, Kawai Manabu, Hirono Seiko, Ina Shinomi, Miyazawa Motoki, Fujita Yoichi, Uchiyama Kazuhisa, Yamaue Hiroki
Second Department of Surgery, Wakayama Medical University, School of Medicine, 811-1 Kimiidera, Wakayama, 641-8510, Japan.
Surg Today. 2009;39(3):219-24. doi: 10.1007/s00595-008-3847-y. Epub 2009 Mar 12.
A few randomized controlled trials have questioned the justification of pylorus-preserving pancreaticoduodenectomy (PpPD) for pancreatic cancer and periampullary cancer. However, the characteristics of pancreatic cancer are remarkably different from those of other periampullary cancers, so the outcomes of PD and PpPD for pancreatic cancer are being re-evaluated.
We studied retrospectively, 55 patients who underwent PpPD at Wakayama Medical University Hospital between 1999 and 2005, when PpPD was available, for pancreatic head adenocarcinoma. The main outcome measures were the postoperative complications, mortality, and survival of the patients who underwent PpPD vs. those who underwent conventional pancreaticoduodenectomy (PD) for pancreatic adenocarcinoma.
There were no significant differences between PD and PpPD in postoperative complications; however, the incidences of delayed gastric emptying (DGE) differed significantly according to the type of reconstruction (P < 0.01). The body weight ratio and the incidence of diarrhea 6 months after PpPD and PD were similar. Patients treated with PD had a higher duodenal invasion rate than those treated with PpPD (P < 0.05); therefore, the cause-specific survival of the PpPD patients was better than that of the PD patients (P < 0.05).
The surgical outcomes and incidence of postoperative complications in this series suggest that PpPD is an appropriate surgical procedure for pancreatic adenocarcinoma.
一些随机对照试验对保留幽门的胰十二指肠切除术（PpPD）用于治疗胰腺癌和壶腹周围癌的合理性提出了质疑。然而，胰腺癌的特征与其他壶腹周围癌显著不同，因此正在对胰腺癌的胰十二指肠切除术（PD）和保留幽门的胰十二指肠切除术（PpPD）的疗效进行重新评估。
我们回顾性研究了1999年至2005年期间在和歌山县医科大学医院接受PpPD治疗的55例胰头腺癌患者，当时该医院可开展PpPD手术。主要观察指标是接受PpPD手术的患者与接受传统胰十二指肠切除术（PD）治疗胰腺腺癌的患者的术后并发症、死亡率和生存率。
PD组和PpPD组术后并发症无显著差异；然而，根据重建类型，胃排空延迟（DGE）的发生率有显著差异（P<0.01）。PpPD组和PD组术后6个月的体重比和腹泻发生率相似。接受PD治疗的患者十二指肠侵犯率高于接受PpPD治疗的患者（P<0.05）；因此，PpPD组患者的病因特异性生存率优于PD组患者（P<0.05）。
本系列研究中的手术结果和术后并发症发生率表明，PpPD是治疗胰腺腺癌的一种合适的手术方法。
