Ueno Tomio, Takashima Motonari, Iida Michihisa, Yoshida Shin, Suzuki Nobuaki, Oka Masaaki
Department of Digestive Surgery and Surgical Oncology (Department of Surgery II), Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-kogushi, Ube, Yamaguchi, 755-8505, Japan.
J Hepatobiliary Pancreat Surg. 2009;16(3):300-4. doi: 10.1007/s00534-009-0054-1. Epub 2009 Mar 13.
Early delayed gastric emptying (DGE) is the most common complication after pylorus-preserving pancreatoduodenectomy (PpPD). Recently, a vertical antecolic reconstruction for duodenojejunostomy was recommended to decrease the incidence of early DGE in patients with Billroth II-type reconstruction after PpPD. However, Billroth I-type reconstruction (B-I) after PpPD is still favored in Japan.
Twelve consecutive patients with B-I were prospectively enrolled. Our technique includes an end-to-side duodenojejunostomy and alignment of the stomach contours with fixation of the greater omentum to the abdominal wall in order to promote passage from the stomach through the jejunal loop. DGE was evaluated according to the consensus definition of the International Study Group of Pancreatic Surgery (ISGPS).
DGE was absent, with the nasogastric tube removed within 3 days in all patients. Mean duration of nasogastric tube placement was 1.5 +/- 0.4 days. Mean maximum suction volume was 85 +/- 32 ml/day.
Preliminary results were encouraging simply with relief of the outflow disturbance around the duodenojejunostomy in patients with B-I after PpPD. These findings warrant further prospective randomized trials at either multiple or high-volume centers.
早期胃排空延迟（DGE）是保留幽门胰十二指肠切除术（PpPD）后最常见的并发症。最近，有人推荐十二指肠空肠吻合术采用垂直结肠前重建，以降低PpPD后毕Ⅱ式重建患者早期DGE的发生率。然而，在日本，PpPD后的毕Ⅰ式重建（B-I）仍然更受青睐。
前瞻性纳入12例连续的B-I患者。我们的技术包括端侧十二指肠空肠吻合术以及使胃轮廓对齐，并将大网膜固定于腹壁，以促进胃内容物通过空肠袢。根据国际胰腺手术研究组（ISGPS）的共识定义评估DGE。
所有患者均未发生DGE，鼻胃管均在3天内拔除。鼻胃管放置的平均时间为1.5±0.4天。平均最大吸出量为85±32ml/天。
PpPD后B-I患者仅通过缓解十二指肠空肠吻合口周围的流出道障碍，初步结果令人鼓舞。这些发现值得在多个或大容量中心进行进一步的前瞻性随机试验。
