Kozuschek W, Reith H B, Waleczek H, Haarmann W, Edelmann M, Sonntag D
Surgical Clinic, Ruhr University Bochum, Germany.
J Am Coll Surg. 1994 May;178(5):443-53.
The standard Whipple procedure involves intestinal disturbances, such as dumping, diarrhea, dyspeptic complaints and the occurrence of ulcers of the anastomoses. A postoperative weight loss was observed ranging between 10 and 40 kilograms. Only a few patients were able to compensate after several months. It was thought that preservation of the intact stomach would prevent the complications arising from a loss of gastric reservoir function and thus the malnutrition could be improved postoperatively. Between 1985 and March 1992, we performed the pylorus-preserving Whipple procedure and treated a group of 43 patients with this method. In the same period, 15 patients were operated upon with the standard Whipple procedure. The present evaluation of the accumulated patient data, including extensive functional studies, led to the following results comparing the pylorus preserving Whipple procedure with the standard Whipple procedure. First, the capacity for food uptake and the development of body weight postoperatively is significantly better. Second, gastric or jejunal ulcers were not observed. Third, there were no clinical signs of digestive disorders, such as different forms of dumping. Nutrition and digestion were not impeded by the preserved opening mechanism of the pylorus. Fourth, the postoperative exocrine function was only slightly decreased. Fifth, glucose metabolism postoperatively was influenced only slightly by preservation of the pylorus. In taking the results of all the examinations into consideration, it can be said that the restricted organ loss in the Whipple procedure with pylorus preservation leaves the secretory and functional capacity of the upper part of the gastrointestinal tract almost unchanged.
标准的惠普尔手术会引发肠道紊乱，如倾倒综合征、腹泻、消化不良症状以及吻合口溃疡的发生。术后观察到体重减轻范围在10至40千克之间。只有少数患者在数月后能够恢复。人们认为保留完整的胃可以预防因胃储存功能丧失而产生的并发症，从而改善术后营养不良的状况。1985年至1992年3月期间，我们实施了保留幽门的惠普尔手术，并采用该方法治疗了一组43例患者。同期，有15例患者接受了标准的惠普尔手术。对积累的患者数据进行的当前评估，包括广泛的功能研究，得出了以下将保留幽门的惠普尔手术与标准惠普尔手术相比较的结果。首先，术后的食物摄取能力和体重增长情况明显更好。其次，未观察到胃或空肠溃疡。第三，没有消化紊乱（如不同形式的倾倒综合征）的临床症状。幽门保留的开放机制未妨碍营养和消化。第四，术后外分泌功能仅略有下降。第五，保留幽门对术后葡萄糖代谢的影响也很小。综合所有检查结果来看，可以说在保留幽门的惠普尔手术中，器官损失受限，使得胃肠道上部的分泌和功能能力几乎未变。
