Royall D, Jeejeebhoy K N, O'Connor B, Taylor B R, Langer B, McLeod R S
Department of Medicine, University of Toronto, Ontario, Canada.
J Am Coll Nutr. 1996 Feb;15(1):73-8. doi: 10.1080/07315724.1996.10718567.
Despite the potential for nutritional deficits in patients undergoing pancreaticoduodenectomy or Whipple procedure, long-term assessment of nutritional status has largely been ignored. This study assessed nutritional status of 24 Whipple patients compared with matched post-cholecystectomy controls.
Clinical assessment was by subjective global assessment, body composition was assessed by bioelectric impedance analysis and functional assessment was by respiratory muscle strength and skeletal muscle function performed by electrical stimulation of the ulnar nerve of the wrist and hand-grip dynamometry.
Whipple patients studied 4.6+/-0.7 years since surgery and controls (4.8+/-0.7 years since surgery) were all judged clinically to be in a good nutritional state. Compared with controls, Whipple patients had significantly lower body weight (Whipple: 72.5+/-2.8 kg, control: 83.9+/-3.3 kg, p<0.05) however, the mean body weight of both Whipple and controls was above ideal weight (Whipple: 113.3+/-4.3%, control: 122.3+/-3.7% p = NS). No significant differences in functional performance were observed between groups. Energy intake of Whipple and controls was also comparable. In the Whipple group, neither the extent of gastric resection or the pathological diagnosis had an effect on the nutritional parameters studied.
Long-term follow-up of patients having undergone Whipple procedure failed to reveal the presence of any nutritional or functional deficits suggesting that a full nutritional recovery is possible after this surgery.
尽管接受胰十二指肠切除术或惠普尔手术的患者存在营养缺乏的可能性，但对营养状况的长期评估在很大程度上被忽视了。本研究评估了24例接受惠普尔手术患者的营养状况，并与匹配的胆囊切除术后对照组进行比较。
通过主观全面评定法进行临床评估，通过生物电阻抗分析评估身体成分，通过对腕部尺神经进行电刺激和握力测量来评估呼吸肌力量和骨骼肌功能进行功能评估。
研究中的惠普尔手术患者术后4.6±0.7年，对照组（术后4.8±0.7年）临床判断均处于良好营养状态。与对照组相比，惠普尔手术患者体重显著更低（惠普尔组：72.5±2.8kg，对照组：83.9±3.3kg，p<0.05），然而，惠普尔组和对照组的平均体重均高于理想体重（惠普尔组：113.3±4.3%，对照组：122.3±3.7%，p=无显著性差异）。两组间功能表现未观察到显著差异。惠普尔组和对照组的能量摄入也相当。在惠普尔组中，胃切除范围或病理诊断对所研究的营养参数均无影响。
对接受惠普尔手术患者的长期随访未发现存在任何营养或功能缺陷，表明该手术后完全恢复营养是可能的。
