Müller M W, Friess H, Beger H G, Kleeff J, Lauterburg B, Glasbrenner B, Riepl R L, Büchler M W
Department of General Surgery, University of Ulm, Germany.
Am J Surg. 1997 Apr;173(4):257-63. doi: 10.1016/S0002-9610(96)00402-3.
After pylorus-preserving Whipple (PPW), delayed gastric emptying (DGE) is reported in up to 50% of these patients. We analyzed gastric emptying and hormonal adaptation of cholecystokinin (CCK), pancreatic polypeptide (PP), and gastrin following two surgical procedures for chronic pancreatitis (CP): the PPW and the duodenum-preserving pancreatic head resection (DPPHR).
Ten patients underwent DPPHR and 10 underwent PPW for CP. Preoperatively and 10 days and 6 months postoperatively, gastric emptying (paracetamol absorption test) and CCK, gastrin, and PP were measured using a test meal stimulation.
The area under the serum paracetamol time curve for 0 to 120 minutes (AUC) showed no preoperative difference. Ten days postoperatively, the AUC was significantly reduced (P <0.05) after PPW but not after DPPHR. Six months postoperatively, AUC was comparable with the preoperative findings in DPPHR and PPW. The integrated 180-minute PP release was significantly reduced 10 days and 6 months postoperatively in both groups. The integrated 180-minute CCK release was decreased 10 days after PPW, but failed to be significant (P = 0.053). Gastrin levels were postoperatively unchanged.
Following DPPHR we found no delay in gastric emptying. In contrast, DGE occurs early after PPW. Our data may help explain the slower recovery in PPW patients with regard to weight gain and relief from pain, which may be due to the functional alteration of gastric emptying and motility after this type of surgery.
在保留幽门的胰十二指肠切除术（PPW）后，高达50%的患者会出现胃排空延迟（DGE）。我们分析了慢性胰腺炎（CP）的两种手术方式——PPW和保留十二指肠的胰头切除术（DPPHR）后胃排空情况以及胆囊收缩素（CCK）、胰多肽（PP）和胃泌素的激素适应性变化。
10例患者接受了DPPHR，10例患者接受了PPW治疗CP。术前以及术后10天和6个月，采用试餐刺激法测量胃排空（对乙酰氨基酚吸收试验）以及CCK、胃泌素和PP。
血清对乙酰氨基酚0至120分钟时间曲线下面积（AUC）术前无差异。术后10天，PPW术后AUC显著降低（P<0.05），而DPPHR术后未降低。术后6个月，DPPHR和PPW的AUC与术前结果相当。两组术后10天和6个月时，180分钟PP的综合释放均显著降低。PPW术后10天，180分钟CCK的综合释放降低，但差异无统计学意义（P = 0.053）。胃泌素水平术后无变化。
DPPHR术后未发现胃排空延迟。相比之下，PPW术后早期会出现DGE。我们的数据可能有助于解释PPW患者在体重增加和疼痛缓解方面恢复较慢的原因，这可能是由于此类手术后胃排空和蠕动的功能改变所致。
