经典非保留幽门胰十二指肠切除术后结肠前与结肠后重建对胃排空延迟的影响。
The effect of antecolic versus retrocolic reconstruction on delayed gastric emptying after classic non-pylorus-preserving pancreaticoduodenectomy.
作者信息
Sahora Klaus, Morales-Oyarvide Vicente, Thayer Sarah P, Ferrone Christina R, Warshaw Andrew L, Lillemoe Keith D, Fernández-Del Castillo Carlos
机构信息
Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
出版信息
Am J Surg. 2015 Jun;209(6):1028-35. doi: 10.1016/j.amjsurg.2014.04.015. Epub 2014 Jul 1.
BACKGROUND
Delayed gastric emptying (DGE) after pancreaticoduodenectomy increases length of hospital stay and costs, and may be influenced by surgical techniques.
METHODS
We retrospectively compared 400 patients with antecolic gastrojejunostomy with 400 patients with retrocolic gastrojejunostomy for the occurrence of DGE.
RESULTS
The prevalence of DGE was 15% in the antecolic group and 21% in the retrocolic group (P = .021), and median length of stay was shorter for the former (8 vs. 10 days, P = .001). The difference was statistically significant with grade A DGE (9% vs. 14%, P = .038), but not B or C. In a multivariate analysis, DGE was influenced by retrocolic reconstruction, as well as older age, chronic pancreatitis, preoperative bilirubin level, a history of previous upper abdominal surgery, and postoperative pancreatic fistula.
CONCLUSIONS
An antecolic gastrojejunostomy for classic non-pylorus-preserving pancreaticoduodenectomy is associated with a lower incidence of mild DGE (grade A) and a shorter length of stay.
背景
胰十二指肠切除术后胃排空延迟（DGE）会增加住院时间和费用，且可能受手术技术影响。
方法
我们回顾性比较了400例行结肠前胃空肠吻合术的患者和400例行结肠后胃空肠吻合术的患者DGE的发生情况。
结果
结肠前组DGE的发生率为15%，结肠后组为21%（P = 0.021），前者的中位住院时间较短（8天对10天，P = 0.001）。A级DGE差异有统计学意义（9%对14%，P = 0.038），但B级或C级无差异。多因素分析显示，DGE受结肠后重建影响，同时还受年龄较大、慢性胰腺炎、术前胆红素水平、既往上腹部手术史及术后胰瘘影响。
结论
经典的非保留幽门胰十二指肠切除术采用结肠前胃空肠吻合术与轻度DGE（A级）发生率较低及住院时间较短相关。
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