保留幽门胰十二指肠切除术后发生胃排空延迟的影响因素分析  

Influencing factor analysis of delayed gastric emptying after pylorus-preserving pancreaticoduodenectomy

作　　者：高红桥[1] 杨尹默[1] 庄岩[1] 王维民[1] 吴问汉[1] 万远廉[1] 黄莚庭[1] 

机构地区：[1]北京大学第一医院普通外科,100034

出　　处：《中华外科杂志》2007年第15期1048-1051,共4页Chinese Journal of Surgery

摘　　要：目的探讨保留幽门胰十二指肠切除术(PPPD)后胃排空延迟(DGE)的影响因素及预防措施。方法回顾性分析2000年1月至2006年7月42例 PPPD 与同期104例标准胰十二指肠切除(SPD)围手术期并发症,对可能影响 PPPD 术后发生 DGE 的原因进行分析。结果 PPPD 与 SPD手术时间、失血量相当,PPPD 组术后胰瘘明显少于 SPD 组,两组术后死亡率差异无统计学意义。PPPD 组 DGE 发生率为35.7%,显著高于 SPD 组的18.3%(P=0.024)。与手术时间<6 h 者相比,手术时间>6 h 者 DGE 发生率明显增加(17.2%对76.9%,P<0.05)。结肠后十二指肠空肠吻合术后DGE 的发生率显著高于结肠前十二指肠空肠吻合者(50%对20%,P=0.043)。多因素分析显示,术后胰瘘、胆瘘等腹腔并发症并非导致 DGE 的危险因素,预防性使用生长抑素也无预防 DGE 的效果。结论 PPPD 术后 DGE 是其最常见的并发症,缩短手术时间、采取结肠前十二指肠空肠吻合可有效降低其发生率,目前尚无确切药物预防方法。Objective To investigate the influencing factors of delayed gastric emptying （DGE） after pylorus-preserving pancreaticoduodenectomy （PPPD） and its preventing managements. Methods Forty- two patients who underwent PPPD and 104 patients underwent standard Whipple procedure （SPD） between January 2000 and July 2006 were investigated retrospectively. The factors influencing the development of DGE following PPPD were analyzed statistically. Results There was no significant difference in mortality between PPPD and SPD （0/42 vs. 7/104, P=0. 193）. Pancreatic fistula occurred much more frequently in SPD than in PPPD （29/104 vs. 1/42, P 〈 0.05） . The occurrence of DGE after PPPD was higher significantly than that after SPD （35.7% vs. 18. 3% , P =0. 024）. More DGE occurred in patients with a operation time more than 6 hours than in patients whose operation lasted less than 6 hours （ 76. 9% vs. 17. 2% , P = 0. 008 ） . Meanwhile, DGE occurred in 20% of patients with the antecolic route for duodenojejunostomy and in 50% with retrocolic route （ P ： 0. 043 ） . Multivariate analysis by logistic regression model showed postoperative intra-abdominal complications were not risk factors for DGE. Prophylactic use of somatostatin couldn＇t prevent DGE effectively. Conclusions DGE is the most frequent postoperative complication after PPPD, it can be markedly reduced by shortening operative time and using antecolic duodenojejunostomy procedure. There is no medicine which could prevent DGE effectively.

关 键 词：胰头十二指肠切除术 胃排空延迟 结肠前十二指肠空肠吻合 结肠后十二指肠空肠吻合 

分 类 号：R656[医药卫生—外科学]