Takami Hideki, Fujii Tsutomu, Kanda Mitsuro, Suenaga Masaya, Yamamura Kazuo, Kodera Yasuhiro
Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan.
World J Surg. 2014 Jul;38(7):1807-13. doi: 10.1007/s00268-014-2469-3.
The clinical significance of preservation of the pyloric ring in total pancreatectomy (TP) has not been elucidated.
A total of 48 consecutive patients underwent TP and were categorized into two groups based on the absence or presence of pylorus resection: the TP (N = 33) and pylorus-preserving TP (PPTP) (N = 15) groups. Preoperative patient background, intraoperative conditions, postoperative complications, and long-term nutritional status were retrospectively compared between the two groups.
Patient background was similar between the groups, with the exception of the prevalence of preoperative diabetes mellitus (55 and 20 %, respectively; p = 0.021). There were no differences between groups with respect to operative times, blood loss, or blood transfusion. The PPTP group was more likely to have postoperative delayed gastric emptying than was the TP group (53 and 21 %, respectively; p = 0.029), and it tended to become increasingly severe. The length of the postoperative fasting period was significantly longer in the PPTP group than in the TP group (mean 15 ± standard deviation [SD] 10.8 and 9 ± 9.7 days, respectively; p = 0.023). The body weights in the TP group started to recover by 1 year postoperatively, whereas those in the PPTP group continued to decrease. Serum hemoglobin levels tended to be higher in the TP group than in the PPTP group at 1 year postoperatively.
Preservation of the pyloric ring provided little or no benefit to short-term outcome or long-term nutritional status among patients who underwent TP.
全胰切除术（TP）中保留幽门环的临床意义尚未阐明。
连续48例患者接受了TP手术，并根据是否进行幽门切除分为两组：TP组（N = 33）和保留幽门的TP组（PPTP组，N = 15）。回顾性比较两组患者的术前背景、术中情况、术后并发症及长期营养状况。
两组患者的背景相似，但术前糖尿病患病率除外（分别为55%和20%；p = 0.021）。两组在手术时间、失血量或输血方面无差异。PPTP组术后胃排空延迟的发生率高于TP组（分别为53%和21%；p = 0.029），且有加重趋势。PPTP组术后禁食期明显长于TP组（平均分别为15±标准差[SD]10.8天和9±9.7天；p = 0.023）。TP组患者体重在术后1年开始恢复，而PPTP组患者体重持续下降。术后1年时，TP组血清血红蛋白水平往往高于PPTP组。
对于接受TP手术的患者，保留幽门环对短期预后或长期营养状况几乎没有益处。
