Department of Gastrointestinal Surgery, All India Institute of Medical Sciences, 1st Floor, P.C Block Ansari Nagar, New Delhi, 110029, India.
J Gastrointest Surg. 2011 May;15(5):843-52. doi: 10.1007/s11605-011-1480-3. Epub 2011 Mar 16.
To study the effect of antecolic vs. retrocolic reconstruction on delayed gastric emptying (DGE) after pancreaticoduodenectomy (PD) and to analyze factors which may be associated with post-PD DGE. DGE is a troublesome complication occurring in 30-40% of patients undergoing PD leading to increased postoperative morbidity. Many factors have been implicated in the pathogenesis of DGE. Among the various methods employed to reduce the incidence, recent reports have suggested that an antecolic reconstruction of gastro/duodenojejunostomy may decrease the incidence of DGE.
Between Sep 2006 and Nov 2008, 95 patients requiring PD (for both malignant and benign conditions) were eligible for the study. Of these, 72 patients finally underwent a PD and were randomized to either a retrocolic or antecolic reconstruction of the gastro/duodenojejunostomy. All patients underwent the standard Whipple's or a pylorus preserving pancreaticoduodenectomy (PPPD), and the randomization was stratified according to the type of PD done. DGE was assessed clinically using the Johns Hopkins criteria (Yeo et al. in Ann Surg 218: 229-37, 1993). In patients suspected to have DGE, mechanical causes were excluded by imaging and/or endoscopy. Occurrence of DGE was the primary endpoint, whereas duration of hospital stay and occurrence of intra-abdominal complications were the secondary end points.
The antecolic and retrocolic groups were comparable with regard to patient demographics, diagnosis, and other preoperative, intraoperative, and postoperative factors. Overall, DGE occurred in 21 patients (30.9%). There was no significant difference in the incidence of DGE in the antecolic vs. the retrocolic group (34.4% vs. 27.8%; p = 0.6). On univariate analysis, older age, use of octreotide, and intra-abdominal complications were significantly associated with the occurrence of DGE; however, on a multivariate analysis, only age was found to be significant (p = 0.02). The mean postoperative stay was longer among patients who developed DGE (21.9 ± 9.3 days vs. 13 ± 6.9 days; p = 0.0001).
Delayed gastric emptying is a cause of significant morbidity and prolongs the duration of hospitalization following pancreaticoduodenectomy. The incidence of DGE does not appear to be related to the method of reconstruction (antecolic or retrocolic). Older age may be a risk factor for its occurrence.
研究胰十二指肠切除术（PD）后结肠前与结肠后重建对胃排空延迟（DGE）的影响，并分析与 PD 后 DGE 相关的因素。DGE 是一种常见并发症，发生率为 30-40%，可导致术后发病率增加。许多因素都与 DGE 的发病机制有关。在降低 DGE 发生率的各种方法中，最近的报道表明，胃/空肠吻合术的结肠前重建可能会降低 DGE 的发生率。
2006 年 9 月至 2008 年 11 月，95 例需要 PD（包括恶性和良性疾病）的患者符合研究条件。其中，72 例最终接受 PD 并随机分为结肠后或结肠前胃/空肠吻合术。所有患者均行标准的 Whipple 或保留幽门的胰十二指肠切除术（PPPD），并根据 PD 类型进行分层随机化。使用约翰霍普金斯标准（Yeo 等人，Ann Surg 218: 229-37, 1993）临床评估 DGE。对于疑似 DGE 的患者，通过影像学和/或内镜排除机械性原因。DGE 的发生是主要终点，而住院时间和腹部并发症的发生是次要终点。
结肠前组和结肠后组在患者人口统计学、诊断以及其他术前、术中及术后因素方面无差异。总体而言，21 例（30.9%）患者发生 DGE。结肠前组与结肠后组 DGE 的发生率无显著差异（34.4%比 27.8%；p=0.6）。单因素分析显示，年龄较大、使用奥曲肽和腹部并发症与 DGE 的发生显著相关；然而，多因素分析仅发现年龄有统计学意义（p=0.02）。发生 DGE 的患者术后住院时间较长（21.9±9.3 天比 13±6.9 天；p=0.0001）。
胃排空延迟是导致 PD 术后发病率显著增加和住院时间延长的原因。DGE 的发生率似乎与重建方法（结肠前或结肠后）无关。年龄较大可能是其发生的危险因素。
