Itani K M, Coleman R E, Meyers W C, Akwari O E
Ann Surg. 1986 Dec;204(6):655-64. doi: 10.1097/00000658-198612000-00007.
Since 1978, 252 patients from different centers in the world have undergone pylorus-preserving pancreatoduodenectomy. Fifty-five per cent of the patients had malignant tumors in the region of the head of the pancreas. The overall operative mortality rate was 2.8%. Anastomotic leakage and fistulae occurred in 19% of the patients. Pancreatic, biliary, and enteric fistulae represented 11%, 4%, and 4%, respectively. Peptic ulcers were subsequently diagnosed in seven patients (3%), two of whom required vagotomy and antrectomy. Delayed recovery of gastric function was the most common complication of this operation, with an overall incidence of 30%. Although the cause of this gastric dysfunction is unknown, its transient nature in most patients makes expectant therapy with gastric tube drainage the best remedy when the problem is encountered. Pylorus-preserving pancreatoduodenectomy decreased the incidence of postgastric surgery syndromes that are commonly associated with the standard Whipple operation. The existing data support the continued use of the operation and the need for future laboratory and clinical investigation of its physiologic impact.
自1978年以来，来自世界各地不同中心的252例患者接受了保留幽门的胰十二指肠切除术。55%的患者在胰头区域患有恶性肿瘤。总体手术死亡率为2.8%。19%的患者发生吻合口漏和瘘。胰瘘、胆瘘和肠瘘分别占11%、4%和4%。随后有7例患者（3%）被诊断为消化性溃疡，其中2例需要行迷走神经切断术和胃窦切除术。胃功能延迟恢复是该手术最常见的并发症，总体发生率为30%。虽然这种胃功能障碍的原因尚不清楚，但在大多数患者中它具有短暂性，因此当遇到这个问题时，采用胃管引流的期待疗法是最佳治疗方法。保留幽门的胰十二指肠切除术降低了通常与标准惠普尔手术相关的胃手术后综合征的发生率。现有数据支持继续使用该手术，并支持未来对其生理影响进行实验室和临床研究的必要性。
