Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.
J Surg Oncol. 2014 Jun;109(7):690-6. doi: 10.1002/jso.23566. Epub 2014 Mar 12.
Pylorus-preserving pancreatoduodenectomy (PPPD) has been associated with a high incidence of delayed gastric emptying (DGE). There are few studies comparing DGE associated with PPPD and subtotal stomach-preserving pancreatoduodenectomy (SSPPD). Moreover, differences between the procedures with respect to long-term results have not been reported. A prospective randomized study was conducted to compare perioperative complications and long-term nutritional status with PPPD and SSPPD.
One hundred patients with periampullary lesions were randomized to receive either PPPD (n = 50) or SSPPD (n = 50). All patients were followed up for 3 years after surgery or to the time of recurrence to evaluate nutritional status for the study. The effects of the procedure, age, and malignancy on changes in nutritional indicators were estimated with linear mixed models. This study was registered at UMIN Clinical Trials Registry (UMIN 000012337).
The incidence of DGE assessed by the International Study Group of Pancreatic Surgery was 20% with PPPD and 12% with SSPPD (P = 0.414). There were no significant differences between the two procedures on postoperative serum albumin levels, serum total cholesterol levels, and body mass index during the 3-year follow-up period.
SSPPD is equally effective in DGE occurrence rate and long-term nutritional status comparing to PPPD.
保留幽门的胰十二指肠切除术（PPPD）与较高的胃排空延迟（DGE）发生率相关。比较 PPPD 和保留部分胃的胰十二指肠切除术（SSPPD）与 DGE 相关的研究较少。此外，尚未报道两种手术方法在长期结果方面的差异。本前瞻性随机研究旨在比较 PPPD 和 SSPPD 围手术期并发症和长期营养状况。
100 例壶腹周围病变患者随机分为 PPPD 组（n=50）和 SSPPD 组（n=50）。所有患者在术后 3 年或复发时进行随访，以评估研究的营养状况。采用线性混合模型估计手术、年龄和恶性肿瘤对营养指标变化的影响。本研究在 UMIN 临床试验注册处（UMIN 000012337）进行了注册。
国际胰腺外科研究组评估的 DGE 发生率为 PPPD 组 20%，SSPPD 组 12%（P=0.414）。在 3 年随访期间，两种手术方法在术后血清白蛋白水平、血清总胆固醇水平和体重指数方面均无显著差异。
与 PPPD 相比，SSPPD 在 DGE 发生率和长期营养状况方面同样有效。
