Kajiwara T, Fukuhara T, Okuno T, Hashimoto T, Takamine Y, Konishi Y, Tani T
First Department of Surgery, Kobe City General Hospital, Japan.
Hepatogastroenterology. 1994 Dec;41(6):533-6.
Palliative operation plays an important part in the treatment of periampullary carcinoma. However, gastric bypass such as the widely practiced side-to-side gastrojejunostomy frequently fails to provide adequate drainage. Here we attempted to fashion an end-to-end duodenojejunostomy in the hope of establishing physiological continuity of the stomach and duodenum. Biliary bypass with side-to-side choledochojejunostomy is performed simultaneously. Eight patients underwent this surgery. In seven of these, radical resection proved to be impossible, and in one the duodeno-biliary decompression was attempted before the radical operation. Early results were satisfactory in all patients. They began to eat liquid meals within a week, and were discharged uneventfully within the third postoperative week, when they were able to eat a regular diet. No ulcer developed in any of the patients. Plasma gastrin levels following a test meal was significantly lower after the operation, but plasma CCK-N and GIP levels showed no statistical difference prior to and after surgery. This duodenojejunal bypass is recommended as a means of improving the quality of the remaining life of the patients.
姑息性手术在壶腹周围癌的治疗中起着重要作用。然而，诸如广泛施行的侧侧胃空肠吻合术之类的胃旁路手术常常无法提供充分的引流。在此，我们尝试施行端端十二指肠空肠吻合术，以期建立胃和十二指肠的生理连续性。同时施行侧侧胆总管空肠吻合术进行胆道旁路。8例患者接受了此手术。其中7例无法进行根治性切除，1例在根治性手术前尝试进行十二指肠-胆道减压。所有患者的早期结果均令人满意。他们在一周内开始进食流食，并在术后第三周顺利出院，此时他们能够进食正常饮食。所有患者均未发生溃疡。术后试餐后血浆胃泌素水平显著降低，但术前和术后血浆CCK-N和GIP水平无统计学差异。推荐采用这种十二指肠空肠旁路术来提高患者的剩余生活质量。
