Bergamaschi R, Mårvik R, Thoresen J E, Ystgaard B, Johnsen G, Myrvold H E
Department of Surgery, and National Center for Advanced Laparoscopic Surgery, University Hospital of Trondheim, Norway.
Surg Laparosc Endosc. 1998 Apr;8(2):92-6.
To assess short-term outcome of open (OGJ) versus laparoscopic (LGJ) gastrojejunostomy in palliation of gastric outlet obstruction (GOO) caused by advanced pancreatic cancer, 22 OGJ patients were compared with 9 diagnosis-matched LGJ controls operated on at the same hospital between 1991 and 1996. Patients undergoing OGJ and LGJ were comparable for age, gender, weight, American Society of Anesthesiologists grading, and previous extensive abdominal surgery, but not for gastroenterostomy performed as a prophylactic procedure (9 vs. 0, respectively). Mortality (5 vs. 1, p = 1.5), overall morbidity (9 vs. 3, p = 0.42), operating time (113.6 +/- 24.5 minutes vs. 125 +/- 15.2 minutes, p < 0.5), time to oral solid food intake (7.2 +/- 0.9 days vs. 5.3 +/- 1.3 days, p < 0.5), nonsteroidal anti-inflammatory drug consumption (7,563.6 +/- 3,381.3 mg vs. 2,044 +/- 673 mg, p < 0.5), opioid consumption (688.5 +/- 258.6 mg vs. 2,910.5 +/- 2,659.9 mg, p < 0.5), delayed-return gastric emptying (5 vs. 1, p = 0.12), postoperative hospital stay (14.6 +/- 1.9 days vs. 10.1 +/- 1.8 days, p < 0.5), survival (5.7 +/- 0.8 months vs. 4.6 +/- 0.6 months, p < 0.5), and further hospital stay before death (9.8 +/- 3.3 days vs. 11.6 +/- 3.4 days, p > 0.5) were not significantly different in 22 OGJ and 9 LGJ patients, respectively. Estimated blood loss was significantly lower in LGJ patients (270.2 +/- 45.8 ml vs. 66 +/- 15.7 ml, p < 0.01). When 13 of 22 patients undergoing OGJ for treatment were compared with 9 LGJ patients, only estimated blood loss (p < 0.01) and hospital stay (p < 0.05) were significantly reduced in LGJ patients. Recurrent GOO before death occurred in one patient (1 of 22, 4.5%) 9 months after OGJ. LGJ for palliative treatment of GOO in advanced pancreatic cancer offered (in spite of the learning curve) reduced estimated blood loss and hospital stay when compared with OGJ.
为评估开放胃空肠吻合术（OGJ）与腹腔镜胃空肠吻合术（LGJ）在缓解晚期胰腺癌所致胃出口梗阻（GOO）方面的短期疗效，将22例行OGJ的患者与1991年至1996年间在同一医院接受手术的9例诊断匹配的LGJ对照患者进行比较。接受OGJ和LGJ的患者在年龄、性别、体重、美国麻醉医师协会分级以及既往广泛腹部手术方面具有可比性，但在作为预防性手术进行的胃肠吻合术方面不可比（分别为9例和0例）。死亡率（5例 vs. 1例，p = 1.5）、总体发病率（9例 vs. 3例，p = 0.42）、手术时间（113.6±24.5分钟 vs. 125±15.2分钟，p < 0.5）、开始经口摄入固体食物的时间（7.2±0.9天 vs. 5.3±1.3天，p < 0.5）、非甾体抗炎药消耗量（7563.6±3381.3毫克 vs. 2044±673毫克，p < 0.5）、阿片类药物消耗量（688.5±258.6毫克 vs. 2910.5±2659.9毫克，p < 0.5）、胃排空延迟（5例 vs. 1例，p = 0.12）、术后住院时间（14.6±1.9天 vs. 10.1±1.8天，p < 0.5）、生存率（5.7±0.8个月 vs. 4.6±0.6个月，p < 0.5）以及死亡前再次住院时间（9.8±3.3天 vs. 11.6±3.4天，p > 0.5）在22例OGJ患者和9例LGJ患者中分别无显著差异。LGJ患者的估计失血量显著更低（270.2±45.8毫升 vs. 66±15.7毫升，p < 0.01）。当将22例行OGJ治疗的患者中的13例与9例LGJ患者进行比较时，仅LGJ患者的估计失血量（p < 0.01）和住院时间（p < 0.05）显著减少。1例接受OGJ治疗的患者（22例中的1例，4.5%）在OGJ术后9个月出现死亡前复发性GOO。与OGJ相比，LGJ用于晚期胰腺癌GOO的姑息治疗（尽管存在学习曲线）可减少估计失血量和住院时间。
