Arlt G, Peiper C, Winkeltau G, Schumpelick V
Chirurgische Klinik, Medizinischen Fakultät, RWTH Aachen, Bundesrepublik Deutschland.
Wien Klin Wochenschr. 1994;106(22):713-7.
Anastomotic ulceration following partial pancreatoduodenectomy carries a substantial risk of complications. More than 50% of patients have episodes of bleeding and up to 20% die as a direct consequence of peptic complications. In a retrospective study of 88 patients, frequency of ulcer was analysed comparing Whipple-Child reconstruction and partial pancreatoduodenectomy with a Roux-Y gastrojejunostomy. Indication was ductal carcinoma of the pancreas in 80 cases and periampullary carcinoma in eight patients. Roux-Y gastrojejunostomy was performed in 53 cases, Billroth-II anastomosis with enteroanastomosis in 35 patients. Perioperative mortality was 7% (n = 6). Nine cases of anastomotic ulceration were verified after Roux-Y gastrojejunostomy (18%). Three out of five Roux patients with a periampullary carcinoma developed ulcers. After Billroth-II reconstruction anastomotic ulceration was found in only one out of 33 cases (3%). Six ulcers presented with bleeding, anastomotic stenosis occurred in two cases. Three ulcer patients with curatively resected periampullary carcinoma were reoperated. After resection of the Roux limb and truncal vagotomy no recurrence was seen during a follow-up period of 19 to 46 months. Roux-Y gastrojejunostomy carries an increased risk of anastomotic ulceration. The lack of inactivation of pepsin by bile acids has to be discussed as an underlying mechanism.
胰十二指肠部分切除术后吻合口溃疡会带来严重的并发症风险。超过50%的患者会出现出血情况，高达20%的患者会因消化性并发症直接死亡。在一项对88例患者的回顾性研究中，分析了采用惠普尔-蔡尔德重建术和胰十二指肠部分切除术加Roux-Y胃空肠吻合术的溃疡发生频率。80例患者的适应症为胰腺癌，8例为壶腹周围癌。53例行Roux-Y胃空肠吻合术，35例行毕罗Ⅱ式吻合加肠吻合术。围手术期死亡率为7%（n = 6）。Roux-Y胃空肠吻合术后证实有9例吻合口溃疡（18%）。5例壶腹周围癌行Roux术式的患者中有3例发生溃疡。毕罗Ⅱ式重建术后，33例中仅1例发现吻合口溃疡（3%）。6例溃疡出现出血，2例发生吻合口狭窄。3例壶腹周围癌根治性切除术后的溃疡患者接受了再次手术。切除Roux肠袢并行迷走神经干切断术后，在19至46个月的随访期内未见复发。Roux-Y胃空肠吻合术吻合口溃疡风险增加。胆汁酸不能使胃蛋白酶失活这一因素必须作为潜在机制加以探讨。
