Kairaluoma M I, Kiviniemi H, Laitinen S, Ståhlberg M
Pancreas. 1987;2(2):146-51. doi: 10.1097/00006676-198703000-00004.
To assess the role of stapling devices and routine gastroenterostomy in palliative bypass surgery, the hospital records of 150 consecutive patients with unresectable, histologically proven pancreatic adenocarcinoma requiring palliative bypass procedure were reviewed. During recent years staplers have gained increasing acceptance for construction of palliative anastomoses. Mortality and morbidity were lower after stapled anastomoses. The use of staplers for construction of double bypass reduced the operation time by 45 min (p less than 0.001). After initial biliary diversion 6% of the patients required later reoperation for gastric outlet obstruction. Routine gastroenterostomy made reoperation unnecessary. Delayed gastric emptying occurred, however, in 10% and significant upper gastrointestinal bleeding in 7% of the patients after prophylactic gastroenterostomy. We conclude that stapling devices are safe and practical in palliative bypass surgery and they significantly reduce operation time if more than one bypass is required. The relatively high incidence of delayed gastric emptying, and significant upper gastrointestinal bleeding after prophylactic gastroenterostomy and the infrequent occurrence of gastric outlet obstruction after initial biliary bypass together with the low mortality after reoperation, suggest that gastroenterostomy should be performed on a selective basis only.
为评估吻合器和常规胃肠吻合术在姑息性旁路手术中的作用，我们回顾了150例连续的、经组织学证实为不可切除的胰腺腺癌且需要进行姑息性旁路手术患者的医院记录。近年来，吻合器在构建姑息性吻合术中越来越被接受。吻合器吻合术后的死亡率和发病率较低。使用吻合器进行双旁路手术可使手术时间缩短45分钟（p<0.001）。在初始胆道转流术后，6%的患者因胃出口梗阻需要再次手术。常规胃肠吻合术可避免再次手术。然而，预防性胃肠吻合术后，10%的患者出现胃排空延迟，7%的患者出现严重上消化道出血。我们得出结论，吻合器在姑息性旁路手术中安全实用，如果需要进行多个旁路手术，可显著缩短手术时间。预防性胃肠吻合术后胃排空延迟和严重上消化道出血的发生率相对较高，初始胆道旁路术后胃出口梗阻发生率较低，再加上再次手术后死亡率较低，这表明胃肠吻合术应仅在选择性基础上进行。
