Tanaka Takayuki, Hidaka Masaaki, Adachi Tomohiko, Matsushima Hajime, Imamura Hajime, Nagakawa Kantoku, Hara Takanobu, Natsuda Koji, Soyama Akihiko, Eguchi Susumu
Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
Cancer Diagn Progn. 2022 Nov 3;2(6):697-701. doi: 10.21873/cdp.10162. eCollection 2022 Nov-Dec.
BACKGROUND/AIM: Braun enteroenterostomy following pancreaticoduodenectomy is a standard procedure. It has been reported to decrease bile reflux and vomiting, prevent reflux gastritis and delay gastric emptying (DGE). However, some reports suggest that the incidence of DGE is unaffected with this procedure. Therefore, in this study, we aimed to investigate whether Braun enteroenterostomy was effective after pancreaticoduodenectomy.
A total of 145 patients who underwent pancreaticoduodenectomy were enrolled and divided into 2 groups i.e., 51 patients with Braun enteroenterostomy (B group) and 94 patients without Braun enteroenterostomy (non-B group). We compared the perioperative data of the patients. Patients who reported postoperative symptoms underwent gastrointestinal endoscopic evaluation.
The incidence of DGE was 7.4% (7/94) and 1.9% (1/51) in the non-B and B groups, respectively (p=0.36), with no significant difference between the groups. During follow-up, some patients reported symptoms including epigastralgia, nausea and melena. The incidence of these symptoms was 27.7% (26 patients; 26/94) and 23.5% (12 patients; 12/51) in non-B and B groups, respectively. Regarding gastrointestinal endoscopic findings, the incidence of anastomotic ulcer was 7.7% (2/26) and 16.7% (2/12) in non-B and B groups, respectively (p=0.40). Bile reflux incidence was 30.8% (8/26) and 0% (0/12) in non-B and B groups, respectively (p=0.03).
Though Braun enteroenterostomy was related to bile reflux, it did not affect the incidence of anastomotic and gastric ulcers or DGE. Therefore, it may not be a necessary procedure after pancreaticoduodenectomy.
背景/目的：胰十二指肠切除术后行布朗式肠肠吻合术是一种标准术式。据报道，该术式可减少胆汁反流和呕吐，预防反流性胃炎并延缓胃排空（DGE）。然而，一些报告表明，此术式对DGE的发生率并无影响。因此，在本研究中，我们旨在调查胰十二指肠切除术后布朗式肠肠吻合术是否有效。
总共纳入145例行胰十二指肠切除术的患者，并将其分为两组，即51例行布朗式肠肠吻合术的患者（B组）和94例未行布朗式肠肠吻合术的患者（非B组）。我们比较了两组患者的围手术期数据。报告术后症状的患者接受了胃肠内镜评估。
非B组和B组的DGE发生率分别为7.4%（7/94）和1.9%（1/51）（p = 0.36），两组之间无显著差异。在随访期间，一些患者报告了包括上腹部疼痛、恶心和黑便在内的症状。非B组和B组这些症状的发生率分别为27.7%（26例患者；26/94）和23.5%（12例患者；12/51）。关于胃肠内镜检查结果，非B组和B组吻合口溃疡的发生率分别为7.7%（2/26）和16.7%（2/12）（p = 0.40）。胆汁反流发生率在非B组和B组分别为30.8%（8/26）和0%（0/12）（p = 0.03）。
尽管布朗式肠肠吻合术与胆汁反流有关，但它并不影响吻合口溃疡、胃溃疡或DGE的发生率。因此，它可能不是胰十二指肠切除术后的必要术式。
