Siriwardana Rohan Chaminda, Lokubandara Rajapaksha Walimuni Mudiyanselage Anuradha, De Silva Hewavisenthi Shivanthi Janaki, Liyanage Saumya Kumuduni, Jayatunge Dona Subani Priyangika, Liyanage Chandika Anuradha Habarakada
Department of Surgery, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka.
Department of Pathology, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka.
BMC Gastroenterol. 2017 Jan 21;17(1):19. doi: 10.1186/s12876-017-0573-1.
Delayed gastric emptying and bile reflux are common concerns in long-term survivors after Whipple surgery. The study was designed to assess modified retro colic retro gastric gastrojejunostomy in reducing macro and microscopic bile reflux and impact on dyspepsia related quality of life in long-term survivors.
Out of 43 patients operated, 23 long-term survivors were included. All underwent gastroscopy and bile reflux was grouped as normal, yellowish bile lakes and presence of greenish bile lakes. Six standard gastric biopsies were taken. Microscopic bile reflux index (BRI) was calculated and a score more than 14 was considered significant. Validated Nepean dyspepsia index-short form (NDI-SF) was used to assess the severity of dyspepsia-related quality of life and compared with age and gender-matched control.
The median age was 48 (21-70) years. Median survival of the group was 37 months (6-40). Endoscopically, 20/23 (87%) had macroscopic bile reflux (74% yellowish bile lakes, 13% greenish bile lakes). None had stomal ulcers or macroscopic inflammation. Mean bile reflux index score was 9.7 (range 1.77-34). Mean NDI-SF score of Whipple group was 23.1 (SD 8.88). In controls, mean score was 19.9 (SD 8.23), showing no significant difference (p = 0.245).
Though there was macroscopic bile reflux, clinical symptoms and microscopic changes were minimal. The modified technique had good long-term results.
胰十二指肠切除术后长期存活者中，胃排空延迟和胆汁反流是常见问题。本研究旨在评估改良结肠后胃后胃肠吻合术对减少宏观和微观胆汁反流以及对长期存活者消化不良相关生活质量的影响。
在43例接受手术的患者中，纳入23例长期存活者。所有患者均接受胃镜检查，胆汁反流分为正常、黄色胆汁湖和绿色胆汁湖。取6份标准胃活检标本。计算微观胆汁反流指数（BRI），得分超过14分被认为具有显著性。使用经过验证的内皮恩消化不良指数简表（NDI-SF）评估消化不良相关生活质量的严重程度，并与年龄和性别匹配的对照组进行比较。
中位年龄为48岁（21 - 70岁）。该组的中位生存期为37个月（6 - 40个月）。内镜检查显示，20/23（87%）有宏观胆汁反流（74%为黄色胆汁湖，13%为绿色胆汁湖）。无一例有吻合口溃疡或宏观炎症。平均胆汁反流指数得分为9.7（范围1.77 - 34）。胰十二指肠切除术组的平均NDI-SF得分为23.1（标准差8.88）。对照组的平均得分为19.9（标准差8.23），差异无统计学意义（p = 0.245）。
尽管存在宏观胆汁反流，但临床症状和微观变化 minimal。改良技术具有良好的长期效果。
原文中“minimal”翻译为“最小的；极少的”，这里“临床症状和微观变化 minimal”表述不太完整准确，推测完整意思可能是“临床症状和微观变化极少” 。
