Department of Hepatobiliopancreatic Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China.
Dig Dis Sci. 2013 Nov;58(11):3224-31. doi: 10.1007/s10620-013-2803-x. Epub 2013 Aug 6.
The safety of pancreaticoduodenectomy has improved significantly. However, alkaline reflux gastritis and marginal ulcer are two substantial problems after pancreaticoduodenectomy.
To identify whether Child reconstruction with a modified Braun enteroenterostomy decreases the incidence of alkaline reflux gastritis and marginal ulcer after pancreaticoduodenectomy better than Roux-en-Y reconstruction.
Data on 57 consecutive patients who underwent standard pancreaticoduodenectomy between January 1, 2008 and January 31, 2012 were collected prospectively. Data on early and late complications of the Child reconstruction with a modified Braun enteroenterostomy and Roux-en-Y were gathered. The risk factors of alkaline reflux gastritis and marginal ulcer were also investigated by using univariate and multivariate analyses.
Twenty-five patients received Roux-en-Y and 32 underwent Child reconstruction with a modified Braun enteroenterostomy. Early complications after the two reconstruction methods were insignificant. Significant differences in terms of later postoperative morbidity (P = 0.01) and change in body mass index (P = 0.03) were found 12 months after pancreaticoduodenectomy. No significant difference for alkaline reflux gastritis was observed between the two methods (14.8 vs. 28.6 %, P = 0.24). Marginal ulcer occurred significantly lower in patients with the modified reconstruction than in those with Roux-en-Y reconstruction (11.1 vs. 47.6 %, P = 0.01). Peptic ulcer history, diabetes mellitus, and reconstruction type had a significant effect on marginal ulcer formation.
Child reconstruction with a modified Braun enteroenterostomy offers an advantage with respect to marginal ulcer after standard pancreaticoduodenectomy, potentially decreasing the incidence of alkaline reflux gastritis as effectively as Roux-en-Y reconstruction.
胰十二指肠切除术的安全性已显著提高。然而，碱性反流性胃炎和边缘性溃疡是胰十二指肠切除术后的两个重要问题。
确定改良 Braun 肠肠吻合术的 Child 重建是否比 Roux-en-Y 重建更能降低胰十二指肠切除术后碱性反流性胃炎和边缘性溃疡的发生率。
前瞻性收集 2008 年 1 月 1 日至 2012 年 1 月 31 日期间连续 57 例接受标准胰十二指肠切除术患者的数据。收集改良 Braun 肠肠吻合术和 Roux-en-Y 的 Child 重建术的早期和晚期并发症数据。还通过单因素和多因素分析研究碱性反流性胃炎和边缘性溃疡的危险因素。
25 例患者接受 Roux-en-Y 重建，32 例患者接受改良 Braun 肠肠吻合术的 Child 重建。两种重建方法的早期并发症无显著差异。胰十二指肠切除术后 12 个月，术后发病率（P = 0.01）和体重指数变化（P = 0.03）存在显著差异。两种方法碱性反流性胃炎无显著差异（14.8%比 28.6%，P = 0.24）。改良重建的边缘性溃疡发生率明显低于 Roux-en-Y 重建（11.1%比 47.6%，P = 0.01）。消化性溃疡病史、糖尿病和重建类型对边缘性溃疡形成有显著影响。
改良 Braun 肠肠吻合术的 Child 重建术在标准胰十二指肠切除术后边缘性溃疡方面具有优势，可能与 Roux-en-Y 重建术一样有效地降低碱性反流性胃炎的发生率。
