Department of Gastrointestinal Surgery & Liver Transplantation, All India Institute of Medical Sciences, New Delhi, India.
Department of Gastrointestinal Surgery & Liver Transplantation, All India Institute of Medical Sciences, New Delhi, India.
Hepatobiliary Pancreat Dis Int. 2017 Aug 15;16(4):353-363. doi: 10.1016/S1499-3872(17)60037-7.
A number of definitions have been used for delayed gastric emptying (DGE) after pancreatoduodenectomy and the reported rates varied widely. The International Study Group of Pancreatic Surgery (ISGPS) definition is the current standard but it is not used universally. In this comprehensive review, we aimed to determine the acceptance rate of ISGPS definition of DGE, the incidence of DGE after pancreatoduodenectomy and the effect of various technical modifications on its incidence.
We searched PubMed for studies regarding DGE after pancreatoduodenectomy that were published from 1 January 1980 to 1 July 2015 and extracted data on DGE definition, DGE rates and comparison of DGE rates among different technical modifications from all of the relevant articles.
Out of 435 search results, 178 were selected for data extraction. The ISGPS definition was used in 80% of the studies published since 2010 and the average rates of DGE and clinically relevant DGE were 27.7% (range: 0-100%; median: 18.7%) and 14.3% (range: 1.8%-58.2%; median: 13.6%), respectively. Pylorus preservation or retrocolic reconstruction were not associated with increased DGE rates. Although pyloric dilatation, Braun's entero-enterostomy and Billroth II reconstruction were associated with significantly lower DGE rates, pyloric ring resection appears to be most promising with favorable results in 7 out of 10 studies.
ISGPS definition of DGE has been used in majority of studies published after 2010. Clinically relevant DGE rates remain high at 14.3% despite a number of proposed surgical modifications. Pyloric ring resection seems to offer the most promising solution to reduce the occurrence of DGE.
胰十二指肠切除术后（PD）胃排空延迟（DGE）的定义有很多，报道的发生率差异很大。国际胰腺外科研究组（ISGPS）的定义是目前的标准，但并未普遍使用。在这项全面的综述中，我们旨在确定 ISGPS 对 DGE 的定义的接受率、PD 后 DGE 的发生率以及各种技术改良对其发生率的影响。
我们在 PubMed 上搜索了 1980 年 1 月 1 日至 2015 年 7 月 1 日期间发表的有关 PD 后 DGE 的研究，并从所有相关文章中提取了关于 DGE 定义、DGE 发生率以及不同技术改良之间 DGE 发生率比较的数据。
在 435 个搜索结果中，有 178 个被选作数据提取。自 2010 年以来发表的研究中，80%使用了 ISGPS 定义，DGE 和临床相关 DGE 的平均发生率分别为 27.7%（范围：0-100%；中位数：18.7%）和 14.3%（范围：1.8%-58.2%；中位数：13.6%）。保留幽门或结肠后重建与 DGE 发生率增加无关。尽管幽门扩张、Braun 肠肠吻合术和 Billroth II 重建与明显较低的 DGE 发生率相关，但幽门环切除术似乎最有前途，10 项研究中有 7 项结果良好。
ISGPS 对 DGE 的定义已在 2010 年后发表的大多数研究中使用。尽管提出了许多手术改良，但临床相关 DGE 的发生率仍高达 14.3%。幽门环切除术似乎是降低 DGE 发生率的最有前途的方法。
