Heise J W, Becker H, Borchard F, Röher H D
Klinik für Allgemeine und Unfallchirurgie, Heinrich-Heine-Universität Düsseldorf.
Chirurg. 1994 Sep;65(9):780-4.
Between 1986 and 1993 fifty-two patients with ductal adenocarcinoma of the pancreatic head underwent pancreatoduodenectomy, 34 in a standard Whipple technique (Whipple), 18 since 1990 preserving the pylorus (PPPD). Operating time was significantly longer for Whipple compared to PPPD (5.5 +/- 1.4 vs. 3.8 +/- 1.0; p < 0.01). Postoperative morbidity (32 vs. 56%) resulted to 50% after PPPD of early postoperative delayed gastric emptying. Hospital mortality was 6% vs. none, respectively. Histopathologic workup of 28 node positive Whipple specimens revealed node involvement in only 11% along the stomach (1) or the pyloric region (2), but in these cases tumors had obviously close relation to the gastric outlet as the reason to chose Whipple. Actuarial survival was very similar in both groups, being 41 vs. 53% at one year, 13 vs. 18% at two years, and only 3.3% at five years for the whole cohort. In conclusion distal gastric resection in Whipple's procedure in ductal carcinoma is oncologically not effective. There is no hazard for survival relating to the preservation of the pylorus. Therefore PPPD as the technically less expensive and for nutritional status more beneficial operation should be the procedure of choice also for this type of tumor.
1986年至1993年间，52例胰头导管腺癌患者接受了胰十二指肠切除术，其中34例采用标准的惠普尔手术（Whipple），18例自1990年起采用保留幽门的手术（PPPD）。与PPPD相比，Whipple手术时间明显更长（5.5±1.4小时对3.8±1.0小时；p<0.01）。PPPD术后早期胃排空延迟导致术后发病率为50%（分别为32%和56%）。医院死亡率分别为6%和0%。对28例Whipple手术标本淋巴结阳性的组织病理学检查显示，仅11%的病例沿胃（1例）或幽门区域（2例）有淋巴结受累，但在这些病例中，肿瘤与胃出口明显关系密切，这是选择Whipple手术的原因。两组的精算生存率非常相似，整个队列一年时分别为41%和53%，两年时为13%和18%，五年时仅为3.3%。总之，在导管癌的Whipple手术中进行远端胃切除在肿瘤学上无效。保留幽门对生存没有危害。因此，PPPD作为技术上成本较低且对营养状况更有益的手术，也应成为这类肿瘤的首选手术方式。
