Department of HBP and Liver Transplant Surgery, University Hospital Complex Badajoz, University of Extremadura, Avda de Elvas s/n, 06080, Badajoz, Spain.
Updates Surg. 2020 Dec;72(4):1105-1113. doi: 10.1007/s13304-020-00823-5. Epub 2020 Jun 5.
Infra-ampullary duodenal lesions are rare and surgical management is controversial. Reconstruction after resection is usually performed by end-to-end or end-to-side duodenojejunostomy. The goal was to analyze our experience, perioperative management, and results after side-to-side duodenojejunostomy. Therefore, we retrospectively evaluated short- and long-term results of surgical resections of third and fourth duodenal portions for several kinds of lesions and reconstruction through duodenojejunostomy performed in our facilities between January 2012 and December 2018. In total, 12 patients were selected for our study, six were male. The median age was 66.3 (IQR: 77.3-59.4). Lesion classification was as follows: 6 cases (50%) of duodenal adenocarcinoma, 4 cases (33.3%) of gastrointestinal stromal tumors (GISTs), and 2 cases (16.7%) of benign pathology. The most frequent clinical presentation was obstruction with vomiting. The surgical technique of choice was resection of third and fourth duodenal portions with a segment of proximal jejunum. Digestive continuity was restored through side-to-side duodenojejunostomy in 11 cases (91.6%). The median operation time was 182.5 min (IQR 237.5-136.3 min). Nine of the 12 patients (75%) did not receive intra- or postoperative blood transfusions. Six patients (50%) experienced complications during post-op. Four of them (33%) experienced major complications (Clavien-Dindo > IIIa) and three required re-op. The median follow-up was 58.3 (95% CI 15-101.5) months. Of the 11 patients with long-term follow-up, 10 have remained asymptomatic during follow-up. The average disease-free survival (DFS) was 43.1 months for adenocarcinoma, and 93 months for GIST. Based on the results of our series, although small, pancreas-sparing duodenectomy could be considered a feasible and safe technique with adequate oncological results. Side-to-side duodenojejunostomy appears to be a safe technique, is easy to perform, and has good functional outcomes. More studies with a larger number of patients are necessary to confirm these findings.
十二指肠下段病变罕见，其手术治疗存在争议。切除后通常采用端端吻合或端侧吻合行十二指肠空肠吻合术进行重建。本研究旨在分析我们在该机构施行的侧侧十二指肠空肠吻合术治疗各种病变的经验、围手术期管理和结果。因此，我们回顾性评估了 2012 年 1 月至 2018 年 12 月间因各种病变接受第三和第四段十二指肠切除术和行十二指肠空肠吻合术患者的短期和长期手术结果。共选择了 12 名患者进行研究，其中 6 名为男性，中位年龄为 66.3（IQR：77.3-59.4）岁。病变分类如下：6 例（50%）为十二指肠腺癌，4 例（33.3%）为胃肠道间质瘤（GISTs），2 例（16.7%）为良性病变。最常见的临床表现为梗阻伴呕吐。首选的手术技术是切除第三和第四段十二指肠，同时切除部分近端空肠。11 例（91.6%）患者采用侧侧十二指肠空肠吻合术恢复消化道连续性。中位手术时间为 182.5min（IQR 237.5-136.3min）。12 例患者中 9 例（75%）未接受术中或术后输血。6 例（50%）患者术后出现并发症。其中 4 例（33%）出现严重并发症（Clavien-Dindo > IIIa），3 例需要再次手术。中位随访时间为 58.3（95%CI 15-101.5）个月。在 11 例长期随访患者中，10 例在随访期间无症状。腺癌的平均无病生存（DFS）为 43.1 个月，GIST 为 93 个月。基于本研究结果，尽管病例数较少，但保留胰腺的十二指肠切除术可能是一种可行且安全的技术，且具有足够的肿瘤学结果。侧侧十二指肠空肠吻合术是一种安全的技术，易于操作，且具有良好的功能结果。需要更多包含大量患者的研究来证实这些发现。
