Cvetkovic Aleksandar M, Milasinovic Danko Z, Peulic Aleksandar S, Mijailovic Nikola V, Filipovic Nenad D, Zdravkovic Nebojsa D
Faculty of Medical sciences, University in Kragujevac, Svetozara Markovica 69, 34000 Kragujevac, Serbia.
Faculty of Hotel Management and Tourism, Vojvodjanska bb, 36210 Vrnjacka Banja, Serbia; BioIRC, Bioengineering Research and Development Center, Prvoslava Stojanovica 6, 34000 Kragujevac, Serbia.
Comput Methods Programs Biomed. 2014 Nov;117(2):71-9. doi: 10.1016/j.cmpb.2014.08.005. Epub 2014 Aug 26.
The main goal of this study was to numerically quantify risk of duodenal stump blowout after Billroth II (BII) gastric resection. Our hypothesis was that the geometry of the reconstructed tract after BII resection is one of the key factors that can lead to duodenal dehiscence. We used computational fluid dynamics (CFD) with finite element (FE) simulations of various models of BII reconstructed gastrointestinal (GI) tract, as well as non-perfused, ex vivo, porcine experimental models. As main geometrical parameters for FE postoperative models we have used duodenal stump length and inclination between gastric remnant and duodenal stump. Virtual gastric resection was performed on each of 3D FE models based on multislice Computer Tomography (CT) DICOM. According to our computer simulation the difference between maximal duodenal stump pressures for models with most and least preferable geometry of reconstructed GI tract is about 30%. We compared the resulting postoperative duodenal pressure from computer simulations with duodenal stump dehiscence pressure from the experiment. Pressure at duodenal stump after BII resection obtained by computer simulation is 4-5 times lower than the dehiscence pressure according to our experiment on isolated bowel segment. Our conclusion is that if the surgery is performed technically correct, geometry variations of the reconstructed GI tract by themselves are not sufficient to cause duodenal stump blowout. Pressure that develops in the duodenal stump after BII resection using omega loop, only in the conjunction with other risk factors can cause duodenal dehiscence. Increased duodenal pressure after BII resection is risk factor. Hence we recommend the routine use of Roux en Y anastomosis as a safer solution in terms of resulting intraluminal pressure. However, if the surgeon decides to perform BII reconstruction, results obtained with this methodology can be valuable.
本研究的主要目标是对毕Ⅱ式（BII）胃切除术后十二指肠残端破裂的风险进行数值量化。我们的假设是，BII切除术后重建通道的几何形状是导致十二指肠裂开的关键因素之一。我们使用计算流体动力学（CFD）结合有限元（FE）对BII重建胃肠道（GI）的各种模型进行模拟，以及非灌注的离体猪实验模型。作为FE术后模型的主要几何参数，我们采用了十二指肠残端长度以及胃残端与十二指肠残端之间的倾斜度。基于多层计算机断层扫描（CT）DICOM对每个3D FE模型进行虚拟胃切除。根据我们的计算机模拟，重建GI道几何形状最理想和最不理想的模型之间，十二指肠残端最大压力的差异约为30%。我们将计算机模拟得出的术后十二指肠压力与实验中十二指肠残端裂开压力进行了比较。根据我们在离体肠段上的实验，计算机模拟得出的BII切除术后十二指肠残端压力比裂开压力低4至5倍。我们的结论是，如果手术技术操作正确，重建GI道的几何形状变化本身不足以导致十二指肠残端破裂。使用ω袢进行BII切除术后，十二指肠残端产生的压力只有与其他危险因素共同作用时才会导致十二指肠裂开。BII切除术后十二指肠压力升高是一个危险因素。因此，就产生的腔内压力而言，我们建议常规使用Roux-en-Y吻合术作为更安全的解决方案。然而，如果外科医生决定进行BII重建，用这种方法获得的结果可能会很有价值。
