Fedele S, Bizzoca C, Delvecchio A, Lafranceschina S, Papagni V, Picciariello A, Pisicchio S, Basile R, Vincenti L
G Chir. 2018 Nov-Dec;39(6):399-402.
The rate of pancreaticoduodenectomy (PD) performed for both benign and malignant periampullary diseases has increased. In addition, Roux-en-Y reconstruction after distal gastrectomy for cancer or ulcer is still widely used. Therefore, a surgeon may be confronted with a partially- gastrectomized patient who needs a PD. This is a very challenging circumstance for surgeons because of adhesions, bloodstream, anatomical changes and length of the remnant intestine. In our experience, we performed two pancreaticoduodenectomies after distal gastrectomy in patients with periampullary tumors. We preserve gastrojejunal anastomosis and perform an end-to-side pancreaticojejunostomy (PJ) on the afferent limb of gastrojejunal anastomosis and a termino-lateral hepaticojejunal anastomosis on an independent transmesocolic Roux-en-Y limb. In literature, few cases of PD after distal gastrectomy are reported and most of them consider only PD after Billroth II reconstruction. Many authors have demonstrated pancreaticogastrostomy (PG) is superior to PJ in terms of lower risk of pancreatic and biliary fistula, but it is not possible to anastomose pancreas stump with gastric wall in patients who have been undergone distal gastrectomy. For this reason, we retrospectively review our experience about PD following distal gastrectomy and suggest a novel standardized technique which allow surgeons to benefit from same advantages of a typical PG also in this group of patients.
因良性和恶性壶腹周围疾病而行胰十二指肠切除术（PD）的比例有所增加。此外，因癌症或溃疡行远端胃切除术后的Roux-en-Y重建仍被广泛应用。因此，外科医生可能会遇到需要行PD的部分胃切除患者。由于粘连、血运、解剖结构改变以及残余肠管长度等问题，这对外科医生来说是极具挑战性的情况。根据我们的经验，我们对两名壶腹周围肿瘤患者在远端胃切除术后实施了胰十二指肠切除术。我们保留胃空肠吻合口，并在胃空肠吻合口的输入袢上进行端侧胰空肠吻合术（PJ），在独立的经结肠系膜Roux-en-Y袢上进行端侧肝空肠吻合术。在文献中，远端胃切除术后行PD的病例报道较少，且大多数仅考虑毕Ⅱ式重建术后的PD。许多作者已证明，在胰瘘和胆瘘风险较低方面，胰胃吻合术（PG）优于PJ，但对于已行远端胃切除的患者，无法将胰腺残端与胃壁吻合。因此，我们回顾性分析了远端胃切除术后行PD 的经验，并提出一种新颖的标准化技术，使外科医生在这类患者中也能受益于典型PG的相同优势。
