Li Xu, Qin Tingting, Zhu Feng, Wang Min, Dang Chao, He Li, Pan Shutao, Liu Yuhui, Yin Taoyuan, Feng Yecheng, Wang Xin, Yu Yahong, Shen Ming, Lu Xingpei, Chen Yongjun, Jiang Li, Shi Chenjian, Qin Renyi
Department of Biliary-Pancreatic Surgery, Affiliated Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Ave., Wuhan, 430030, Hubei, China.
J Gastrointest Surg. 2021 Aug;25(8):2172-2183. doi: 10.1007/s11605-021-05024-y. Epub 2021 May 5.
Delayed gastric emptying (DGE) is a common complication following laparoscopic pancreaticoduodenectomy (LPD), although it remains incompletely understood, and only few studies have investigated the clinical benefits of hepatic branch of the vagus nerve (HBVN) preservation on DGE after LPD until now. We intended to evaluate the effect of preservation of the HBVN during LPD on the incidence of DGE.
A total of 274 consecutive LPDs performed at a single center between July 2014 and December 2019 with available videos were retrospectively reviewed. DGE was defined according to the International Study Group of Pancreatic Surgery (ISGPS) criteria, and HBVN condition during the LPD procedure was evaluated through a video review. Risk factors associated with DGE were assessed by performing univariate and multivariate logistic regression analyses. Postoperative outcomes between the HBVN-preserved and HBVN-injury groups were compared before and after propensity score matching (PSM).
One hundred fifty-six (56.93%) patients underwent LPD with HBVN-preserved and 118 (43.07%) with HBVN injury. DGE occurred in 33.2% of patients (n = 91) with grades B and C occurring at 13.9% (n = 38) and 7.7% (n = 21), respectively. Longer operative time, more EIBL, HBVN injury, POPF (grades B and C), postoperative hemorrhage, intra-abdominal infection, and Clavien-Dindo ≥III were identified as risk factors for DGE in the univariate analysis. Then, in the multivariate analysis, HBVN injury and intra-abdominal infection were found to be independent risk factors affecting the incidence of DGE (any grade) or clinically relevant DGE (grades B and C). Furthermore, the prevalence of DGE was significantly higher in the HBVN-injury group than in the HBVN-preserved group before and after PSM analysis (46.61% vs. 23.08%, P<0.001; 42.59% vs. 23.15%, P=0.013).
HBVN preservation during LPD might be associated with a reduced incidence of DGE as a framework for prospective quality improvement.
尽管腹腔镜胰十二指肠切除术（LPD）后胃排空延迟（DGE）这一常见并发症仍未被完全理解，且迄今为止仅有少数研究探讨了保留迷走神经肝支（HBVN）对LPD术后DGE的临床益处。我们旨在评估LPD术中保留HBVN对DGE发生率的影响。
回顾性分析2014年7月至2019年12月在单一中心连续进行的274例有可用视频的LPD病例。根据国际胰腺手术研究组（ISGPS）标准定义DGE，并通过视频回顾评估LPD手术过程中的HBVN情况。通过单因素和多因素逻辑回归分析评估与DGE相关的危险因素。在倾向评分匹配（PSM）前后比较保留HBVN组和HBVN损伤组的术后结局。
156例（56.93%）患者LPD术中保留了HBVN，118例（43.07%）患者HBVN受损。91例（33.2%）患者发生DGE，其中B级和C级分别占13.9%（n = 38）和7.7%（n = 21）。单因素分析确定手术时间延长、更多的术中出血、HBVN损伤、胰瘘（B级和C级）、术后出血、腹腔内感染以及Clavien-Dindo≥III级为DGE的危险因素。随后，多因素分析发现HBVN损伤和腹腔内感染是影响DGE（任何级别）或临床相关DGE（B级和C级）发生率的独立危险因素。此外，PSM分析前后，HBVN损伤组的DGE患病率均显著高于保留HBVN组（46.61%对23.08%，P<0.001；42.59%对23.15%，P = 0.013）。
LPD术中保留HBVN可能与DGE发生率降低相关，可作为前瞻性质量改进的框架。
