胰十二指肠切除术后胃排空延迟的机制：胃空肠吻合口解剖位置的影响。

Impact of the gastrojejunal anatomic position as the mechanism of delayed gastric emptying after pancreatoduodenectomy.

机构信息

Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.

出版信息

Surgery. 2018 May;163(5):1063-1070. doi: 10.1016/j.surg.2017.11.016. Epub 2018 Jan 8.

DOI:10.1016/j.surg.2017.11.016

PMID:29325788

Abstract

BACKGROUND

This study investigated the impact of gastrojejunal anatomic position on the incidence of delayed gastric emptying after pancreatoduodenectomy.

METHODS

A total of 160 patients were included in the retrospective analysis. The relative anatomic position of the gastrojejunostomy was evaluated using coronal and sagittal plane computed tomography images on postoperative day 7; the coronal cardia anastomotic angle and the sagittal fundus anastomotic angle were measured. In the validation study, 64 consecutive patients were enrolled, and gastric emptying was evaluated using water-soluble contrast medium. The extent of gastric emptying was graded as grade I (no gastric dilatation and no stasis), grade II (gastric dilatation but no stasis), or grade III (gastric dilatation and stasis).

RESULTS

Patients with grades B (n = 8) and C (n = 22) delayed gastric emptying were included in the delayed gastric emptying group (n = 30), and the others were included in the nondelayed gastric emptying group (n = 130). The coronal cardia anastomotic angle was not significantly different between the 2 groups, whereas the sagittal fundus anastomotic angle was significantly greater in the delayed gastric emptying group compared to the nondelayed gastric emptying group (median 50.3 vs 64.5 degrees, P < .001). Multivariate analysis, including various risk factors of delayed gastric emptying, indicated that a sagittal fundus anastomotic angle >60 degrees was the only independent risk factor of delayed gastric emptying (odds ratio, 16.59). In the validation study, the median degree of sagittal fundus anastomotic angle increased as the gastric emptying grade increased (grade I, 44.3 degrees; grade II, 55.3 degrees; grade III, 60.7 degrees; P = .014 by analysis of variance).

CONCLUSION

The gastrojejunal anatomic position after pancreatoduodenectomy has a significant impact on the incidence of delayed gastric emptying. (Surgery 2017;160:XXX-XXX.).

摘要

背景

本研究旨在探讨胃空肠吻合的解剖位置对胰十二指肠切除术后胃排空延迟的影响。

方法

回顾性分析 160 例患者的临床资料。术后第 7 天行冠状位和矢状位 CT 检查评估胃空肠吻合的相对解剖位置；测量冠状位贲门吻合角和矢状位胃底吻合角。在验证性研究中，连续纳入 64 例患者，使用水溶性对比剂评估胃排空情况。胃排空程度分级为 I 级（无胃扩张和无潴留）、II 级（胃扩张但无潴留）和 III 级（胃扩张和潴留）。

结果

胃排空延迟组（n=30）包括 B 型（n=8）和 C 型（n=22）延迟胃排空患者，无延迟胃排空组（n=130）为其余患者。两组患者冠状位贲门吻合角差异无统计学意义，而延迟胃排空组矢状位胃底吻合角显著大于无延迟胃排空组（中位数 50.3° vs 64.5°，P<0.001）。包括各种胃排空延迟危险因素的多因素分析表明，矢状位胃底吻合角>60°是延迟胃排空的唯一独立危险因素（比值比，16.59）。在验证性研究中，随着胃排空程度的增加，矢状位胃底吻合角的中位数逐渐增加（I 级，44.3°；II 级，55.3°；III 级，60.7°；方差分析，P=0.014）。