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[胰十二指肠切除术后胰肠或胰胃吻合术。一项比较性回顾性研究]

[Pancreatojejunal or pancreatogastric anastomosis after cephalic duodenopancreatectomy. A comparative retrospective study].

作者信息

Tuech J J, Pessaux P, Duplessis R, Villapadierna F, Ronceray J, Arnaud J P

机构信息

Département de chirurgie viscérale, CHU Angers, France.

出版信息

Chirurgie. 1998 Nov;123(5):450-5. doi: 10.1016/s0001-4001(99)80071-3.

Abstract

AIM OF THE STUDY

The aim of this retrospective study was to compare pancreatico-jejunostomy vs pancreatico-gastrostomy with regard to safety of pancreatic anastomosis after pancreatico-duodenectomy.

PATIENTS AND METHODS

From January 1980 to June 1995, 171 patients underwent pancreatico-duodenectomy, 136 for pancreas, ampulla, distal bile duct or duodenum cancers, and 36 for chronic pancreatitis. Pancreatic anastomosis was realised by pancreatico-jejunostomy in 91 cases and by pancreatico-gastrostomy in 80 cases. There was no significant difference between the two groups (age, gender and primary disease). Comparison between the two groups concerned mainly postoperative mortality and morbidity.

RESULTS

The overall postoperative mortality rate was significantly higher in the pancreatico-jejunostomy group (12%) than in the pancreatico-gastrostomy group (3.7%) (P = 0.05); death was directly related to necrosis of the remnant pancreas in four cases among the 14 postoperative deaths. The postoperative morbidity rate was respectively 23% after pancreatico-jejunostomy and 12.5% after pancreatico-gastrostomy; the pancreatic leakage and/or necrosis rate was higher in the pancreatico-jejunostomy group (13%) than in the pancreatico-gastrostomy group (3.75%) (P = 0.029).

CONCLUSION

This study seems to demonstrate the superiority of the pancreatico-gastric anastomosis, but these results have to be confirmed or invalidated by a prospective multicentric randomised trial.

摘要

研究目的

本回顾性研究的目的是比较胰十二指肠切除术后胰肠吻合术与胰胃吻合术在胰腺吻合安全性方面的差异。

患者与方法

1980年1月至1995年6月,171例患者接受了胰十二指肠切除术,其中136例因胰腺、壶腹、远端胆管或十二指肠癌接受手术,36例因慢性胰腺炎接受手术。91例患者采用胰肠吻合术进行胰腺吻合,80例患者采用胰胃吻合术。两组(年龄、性别和原发疾病)之间无显著差异。两组之间的比较主要涉及术后死亡率和发病率。

结果

胰肠吻合术组的总体术后死亡率(12%)显著高于胰胃吻合术组(3.7%)(P = 0.05);14例术后死亡病例中有4例死亡与残余胰腺坏死直接相关。胰肠吻合术后的发病率为23%,胰胃吻合术后为12.5%;胰肠吻合术组的胰腺渗漏和/或坏死率(13%)高于胰胃吻合术组(3.75%)(P = 0.029)。

结论

本研究似乎表明胰胃吻合术具有优越性,但这些结果必须通过前瞻性多中心随机试验来证实或否定。

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