Kishi Takashi, Tajima Yoshitsugu, Hayashi Hikota, Kawabata Yasunari, Uemura Kenichiro, Nagai Minako, Nishio Kohei, Fukuzawa Kengo, Yagi Shintaro, Hidaka Masaaki
Department of General and Digestive Surgery, Shimane University Faculty of Medicine, Izumo, Shimane, Japan.
Department of Surgery, Graduate School of Biomedical and Health Science, Hiroshima University, Hiroshima, Japan.
J Hepatobiliary Pancreat Sci. 2025 Sep;32(9):679-688. doi: 10.1002/jhbp.12182. Epub 2025 Jul 4.
BACKGROUND/PURPOSE: The remnant stomach after distal gastrectomy (DG) which receives its blood supply mainly from the splenic artery (SPA), is at high risk for gastric ischemia following distal pancreatectomy (DP). We investigated the risk factors for ischemic necrosis of the remnant stomach (INS) during or after DP in DG patients.
PATIENTS/METHODS: We collected 414 patients who underwent DP after DG between July 2009 and December 2019 by distributing questionnaires to members of the Japanese Society of Pancreatic Surgery (JSPS) in 2020, and the risk factors for INS were analyzed in 364 eligible patients.
INS developed in 17 (4.7%) patients. A multivariate logistic regression analysis revealed that dissection of the left inferior phrenic artery (LIPA) during DP (odds ratio [OR] 51.9, p < 0.001), current DP for pancreatic cancer (OR 6.19, p = 0.017), and previous DG for gastric cancer (OR 6.12, p = 0.017) were independent risk factors for INS.
Preservation of the LIPA is necessary to avoid INS when DP is performed in DG patients. Additionally, careful surgical management is required in patients undergoing DP for pancreatic cancer and who have undergone DG for gastric cancer because they are candidates for INS after DP.
背景/目的：远端胃切除术后（DG）的残胃主要由脾动脉（SPA）供血，在远端胰腺切除术后（DP）发生胃缺血的风险较高。我们研究了DG患者在DP期间或之后发生残胃缺血性坏死（INS）的危险因素。
患者/方法：我们通过向日本胰腺外科学会（JSPS）成员发放问卷，收集了2009年7月至2019年12月期间接受DG后再行DP的414例患者，并对364例符合条件的患者分析了INS的危险因素。
17例（4.7%）患者发生了INS。多因素logistic回归分析显示，DP期间解剖左膈下动脉（LIPA）（比值比[OR]51.9，p＜0.001）、当前因胰腺癌行DP（OR 6.19，p = 0.017）以及既往因胃癌行DG（OR 6.12，p = 0.017）是INS的独立危险因素。
在DG患者中进行DP时，保留LIPA对于避免INS是必要的。此外，对于因胰腺癌行DP且既往因胃癌行DG的患者，需要进行仔细的手术管理，因为他们是DP后发生INS的高危人群。
