Oida Takatsugu, Kano Hisao, Mimatsu Kenji, Kawasaki Atsushi, Kuboi Youichi, Fukino Nobutada, Kida Kazutoshi, Amano Sadao
Department of Surgery, Yokohama Central Hospital, Yokohama, Japan.
Hepatogastroenterology. 2012 May;59(115):899-902. doi: 10.5754/hge10112.
BACKGROUND/AIMS: Marginal ulceration and delayed gastric emptying are considerable problems after pancreaticoduodenectomy. Helicobacter pylori (HP) are well known to be associated with gastritis, gastric ulcer and gastric cancer. Thus, we studied the relationship between marginal ulceration and delayed gastric emptying in the early postoperative period after pancreaticoduodenectomy with pancreaticogastrostomy.
We retrospectively studied 58 patients who underwent pancreaticoduodenectomy with pancreaticogastrostomy. On the basis of the grade of delayed gastric emptying, these patients were divided into 2 groups-WS group; without/with slight delayed gastric emptying and MS group; moderate/severe delayed gastric emptying.
Two patients (3.4%) developed postoperative marginal ulcer, these 2 patients had no HP infection; moreover, they belonged to the MS group. Five patients in the WS group were infected with HP; although, postoperative marginal ulceration did not develop in these 5 patients.
Delayed gastric emptying might be a stronger promoting factor of postoperative marginal ulcer after pancreaticoduodenectomy with pancreaticogastrostomy rather than HP infection and prevention of delayed gastric emptying is important to reduce the occurrence rate of postoperative marginal ulcer. Our modified subtotal stomach-preserving pancreaticoduodenectomy is a useful procedure for preventing delayed gastric emptying and postoperative marginal ulcer after pancreaticoduodenectomy with pancreaticogastrostomy.
背景/目的：胰十二指肠切除术后，吻合口溃疡和胃排空延迟是相当严重的问题。众所周知，幽门螺杆菌（HP）与胃炎、胃溃疡和胃癌有关。因此，我们研究了胰胃吻合胰十二指肠切除术后早期吻合口溃疡与胃排空延迟之间的关系。
我们回顾性研究了58例行胰胃吻合胰十二指肠切除术的患者。根据胃排空延迟的程度，将这些患者分为两组——WS组，无/轻度胃排空延迟；MS组，中度/重度胃排空延迟。
2例患者（3.4%）发生术后吻合口溃疡，这2例患者无HP感染，且均属于MS组。WS组有5例患者感染HP，但这5例患者未发生术后吻合口溃疡。
胰胃吻合胰十二指肠切除术后，胃排空延迟可能是术后吻合口溃疡的一个更强的促发因素，而非HP感染，预防胃排空延迟对于降低术后吻合口溃疡的发生率很重要。我们改良的保留胃大部胰十二指肠切除术是预防胰胃吻合胰十二指肠切除术后胃排空延迟和术后吻合口溃疡的一种有效术式。
