Department of Surgery, Shiga University of Medical Science, Otsu, Japan.
Division of Clinical Nutrition, Shiga University of Medical Science Hospital, Otsu, Japan.
Eur Surg Res. 2023;64(2):211-219. doi: 10.1159/000525551. Epub 2022 Jun 16.
We investigated the effect of the gastrojejunostomy position on the postoperative oral intake in patients who have undergone pancreaticoduodenectomy (PD).
We investigated 119 patients who underwent PD between June 2013 and December 2019 and examined the effect of the horizontal and vertical distance rates of the gastrojejunostomy position on the postoperative oral intake. The patients were categorized as having poor or good oral intake based on whether their intake was up to half the required calorie intake.
There were significant differences in the number of cases with grade B or C postoperative pancreatic fistula (good, 20.3% vs. poor, 60.0%; p < 0.001), horizontal distance rate (good, 0.57 vs. poor, 0.48; p = 0.02), and postoperative hospitalization period (good, 15 vs. poor, 35 days; p < 0.001). However, there was no significant difference in the vertical distance rate (good, 0.67 vs. poor, 0.71; p = 0.22). The horizontal distance rate was the independent risk factor for postoperative poor oral intake at 2-3 weeks (risk ratio, 3.69; 95% CI: 1.48-9.20).
The oral intake was greater in patients whose gastrojejunostomy position in PD was farther from the median, suggesting the necessity of intraoperative placement of the gastrojejunostomy position as far from the median as possible.
我们研究了胃空肠吻合口位置对胰十二指肠切除术（PD）后患者术后口服摄入的影响。
我们调查了 2013 年 6 月至 2019 年 12 月期间接受 PD 的 119 名患者，并检查了胃空肠吻合口位置的水平和垂直距离率对术后口服摄入的影响。根据患者的摄入量是否达到所需热量摄入的一半，将患者分为摄入不良或良好。
术后胰腺瘘（良好，20.3%；不良，60.0%；p<0.001）、水平距离率（良好，0.57；不良，0.48；p=0.02）和术后住院时间（良好，15 天；不良，35 天；p<0.001）的病例数量存在显著差异。然而，垂直距离率（良好，0.67；不良，0.71；p=0.22）无显著差异。水平距离率是术后 2-3 周口服摄入不良的独立危险因素（风险比，3.69；95%CI：1.48-9.20）。
PD 中胃空肠吻合口位置越远离中线，患者的口服摄入越大，这表明术中胃空肠吻合口位置尽可能远离中线是必要的。
