Second Department of Surgery, Wakayama Medical University School of Medicine, Wakayama, Japan.
Ann Surg. 2011 Mar;253(3):495-501. doi: 10.1097/SLA.0b013e31820d98f1.
To determine in a prospective randomized controlled trial (RCT) whether pylorus-resecting pancreatoduodenectomy (PrPD) with preservation of nearly the entire stomach reduces the incidence of delayed gastric emptying (DGE) compared with pylorus-preserving pancreatoduodenectomy (PpPD).
Several RCTs have compared PpPD and conventional pancreatoduodenectomy with antrectomy. However, no study has reported the difference between PrPD with preservation of nearly the entire stomach and PpPD.
One hundred thirty patients were randomized to preservation of the pylorus ring (PpPD) or to resection of the pylorus ring with preservation of nearly the entire stomach (PrPD). This RCT was registered at clinicaltrials.gov NCT00639314.
The incidence of DGE was 4.5% in PrPD and 17.2% in PpPD, a significant difference. Delayed gastric emptying was classified into 3 categories proposed by the International Study Group of Pancreatic Surgery. The proposed clinical grading classified 11 cases of DGE in PpPD into grades A (n = 6), B (n = 5), and C (n = 0) and one case in PrPD into each of the 3 grades. The time to peak CO2 content in the C-acetate breath test at 1, 3, and 6 months postoperatively was significantly delayed in PpPD compared with PrPD (34.3 ± 24.6 minutes versus 18.7 ± 11.8 minutes, 26.5 ± 21.1 minutes versus 17.3 ± 11.7 minutes, 26.7 ± 18.8 minutes versus 17.4 ± 13.2 minutes, respectively). Pylorus-resecting pancreatoduodenectomy and PpPD had comparable outcomes for quality of life, weight loss, and nutritional status during a 6-month follow-up period.
Pylorus-resecting pancreatoduodenectomy significantly reduces of the incidence of DGE compared with PpPD.
在一项前瞻性随机对照试验（RCT）中确定，与保留幽门的胰十二指肠切除术（PpPD）相比，保留几乎整个胃的幽门切除术（PrPD）是否降低了术后延迟性胃排空（DGE）的发生率。
几项 RCT 比较了 PpPD 和常规胰十二指肠切除术加胃切除术。然而，尚无研究报道保留几乎整个胃的 PrPD 与 PpPD 之间的差异。
将 130 例患者随机分为保留幽门环（PpPD）或保留幽门环加胃大部切除术（PrPD）。这项 RCT 在 clinicaltrials.gov 注册为 NCT00639314。
PrPD 的 DGE 发生率为 4.5%，PpPD 为 17.2%，差异显著。延迟性胃排空分为国际胰腺外科研究组提出的 3 个类别。提出的临床分级将 PpPD 中 11 例 DGE 分为 A 级（n=6）、B 级（n=5）和 C 级（n=0），PrPD 中各有 1 例。术后 1、3 和 6 个月 C-醋酸呼气试验中 CO2 峰值时间在 PpPD 中明显延迟，而在 PrPD 中则无差异（34.3±24.6 分钟比 18.7±11.8 分钟，26.5±21.1 分钟比 17.3±11.7 分钟，26.7±18.8 分钟比 17.4±13.2 分钟）。在 6 个月的随访期间，与 PpPD 相比，PrPD 的生活质量、体重减轻和营养状况相当。
与 PpPD 相比，PrPD 显著降低了 DGE 的发生率。
