胰十二指肠切除术后胃肠吻合的经结肠前与结肠后入路：一项随机对照试验。

Antecolic versus retrocolic route of the gastroenteric anastomosis after pancreatoduodenectomy: a randomized controlled trial.

机构信息

Departments of *Surgery †Dietetics and Nutrition ‡Clinical Epidemiology and Biostatistics, Academic Medical Center, Amsterdam §Department of Surgery, Erasmus Medical Center, Rotterdam ¶Department of Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam ‖Department of Surgery, Maasstad Hospital, Rotterdam **Department of Surgery, Catharina Hospital, Eindhoven ††Department of Surgery, Reinier de Graaf Hospital, Delft ‡‡Department of Surgery, Leiden University Medical Center, Leiden §§Department of Surgery, Medisch Spectrum Twente, Enschede ¶¶Department of Surgery, Jeroen Bosch Hospital, 's-Hertogenbosch; and ‖‖Department of Surgery, Rijnstate Hospital, Arnhem, the Netherlands. Dr Reitsma is now with Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, the Netherlands.

出版信息

Ann Surg. 2014 Jan;259(1):45-51. doi: 10.1097/SLA.0b013e3182a6f529.

DOI:10.1097/SLA.0b013e3182a6f529

PMID:24096769

Abstract

OBJECTIVE

To investigate the relationship between the route of gastroenteric (GE) reconstruction after pancreatoduodenectomy (PD) and the postoperative incidence of delayed gastric emptying (DGE).

BACKGROUND

DGE is one of the most common complications after PD. Recent studies suggest that an antecolic route of the GE reconstruction leads to a lower incidence of DGE, compared to a retrocolic route. In a nonrandomized comparison within our trial center, we found no difference in DGE after antecolic or retrocolic GE reconstruction.

METHODS

Ten middle- to high-volume centers participated in the patient inclusion. Patients scheduled for PD who gave written informed consent were included and randomized during surgery after resection. Standard operation was a pylorus-preserving PD. Primary endpoint was DGE. Secondary endpoints included other complications and length of hospital stay.

RESULTS

There were 125 patients in the retrocolic group, and 121 patients in the antecolic group. Baseline and treatment characteristics did not differ between the study groups. In the retrocolic group, 45 patients (36%) developed clinically relevant DGE compared with 41 (34%) in the antecolic group (absolute risk difference: 2.1%; 95% confidence interval: -9.8% to 14.0%). There were no differences in need for postoperative (par)enteral nutritional support, other complications, hospital mortality, and median length of hospital stay.

CONCLUSIONS

The route of GE reconstruction after PD does not influence the postoperative incidence of DGE or other complications. The etiology and treatment of DGE, which occurs frequently after both procedures, need further investigation. The GE reconstruction after PD should be routed according to the surgeon's preference.

摘要

目的

探讨胰十二指肠切除术（PD）后胃肠（GE）重建途径与术后胃排空延迟（DGE）发生率的关系。

背景

DGE 是 PD 后最常见的并发症之一。最近的研究表明，与结肠后途径相比，结肠前 GE 重建途径可降低 DGE 的发生率。在我们的试验中心进行的非随机比较中，我们发现结肠前或结肠后 GE 重建后 DGE 无差异。

方法

10 家中等到大容量中心参与了患者纳入。给予书面知情同意并计划行 PD 的患者在切除术后手术期间进行随机分组。标准手术为保留幽门的 PD。主要终点是 DGE。次要终点包括其他并发症和住院时间。

结果

结肠后组有 125 例患者，结肠前组有 121 例患者。研究组之间的基线和治疗特征无差异。在结肠后组中，45 例（36%）患者发生临床上相关的 DGE，而结肠前组中 41 例（34%）（绝对风险差异：2.1%；95%置信区间：-9.8%至 14.0%）。术后（肠外）营养支持的需求、其他并发症、医院死亡率和中位住院时间无差异。