Pylorus-preserving pancreaticoduodenectomy versus conventional pancreaticoduodenectomy for pancreatic adenocarcinoma
Pylorus-preserving pancreaticoduodenectomy versus conventional pancreaticoduodenectomy for pancreatic adenocarcinoma
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DOI：
10.1007/s00595-008-3847-y
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发表时间：
2009-03
期刊：
影响因子：
2.5
通讯作者：
M. Tani;M. Kawai;S. Hirono;S. Ina;M. Miyazawa;Y. Fujita;K. Uchiyama;H. Yamaue
中科院分区：
文献类型：
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作者：
M. Tani;M. Kawai;S. Hirono;S. Ina;M. Miyazawa;Y. Fujita;K. Uchiyama;H. Yamaue
目的一些随机对照试验质疑保留幽门的胰十二指肠切除术（PpPD）治疗胰腺癌和壶腹周围癌的合理性。然而，胰腺癌的特点与其他壶腹周围癌有显着不同，因此PD和PpPD治疗胰腺癌的结果正在重新评估。方法我们回顾性研究了1999年至2005年（当PpPD可用时）在和歌山医科大学医院接受PpPD治疗的55例胰头腺癌患者。主要结局指标是接受 PpPD 的患者与接受传统胰十二指肠切除术 (PD) 的胰腺腺癌患者的术后并发症、死亡率和生存率。结果 PD 和 PpPD 的术后并发症没有显着差异；然而，胃排空延迟（DGE）的发生率根据重建类型的不同而存在显着差异（P<0.01）。 PpPD和PD后6个月的体重比和腹泻发生率相似。 PD治疗患者十二指肠受侵率高于PpPD治疗患者（P<0.05）；因此，PpPD患者的病因特异性生存率优于PD患者（P<0.05）。结论本系列手术结果和术后并发症发生率提示PpPD是胰腺癌的合适手术方式。
PurposeA few randomized controlled trials have questioned the justification of pylorus-preserving pancreaticoduodenectomy (PpPD) for pancreatic cancer and periampullary cancer. However, the characteristics of pancreatic cancer are remarkably different from those of other periampullary cancers, so the outcomes of PD and PpPD for pancreatic cancer are being re-evaluated.MethodsWe studied retrospectively, 55 patients who underwent PpPD at Wakayama Medical University Hospital between 1999 and 2005, when PpPD was available, for pancreatic head adenocarcinoma. The main outcome measures were the postoperative complications, mortality, and survival of the patients who underwent PpPD vs. those who underwent conventional pancreaticoduodenectomy (PD) for pancreatic adenocarcinoma.ResultsThere were no significant differences between PD and PpPD in postoperative complications; however, the incidences of delayed gastric emptying (DGE) differed significantly according to the type of reconstruction (P< 0.01). The body weight ratio and the incidence of diarrhea 6 months after PpPD and PD were similar. Patients treated with PD had a higher duodenal invasion rate than those treated with PpPD (P< 0.05); therefore, the cause-specific survival of the PpPD patients was better than that of the PD patients (P< 0.05).ConclusionThe surgical outcomes and incidence of postoperative complications in this series suggest that PpPD is an appropriate surgical procedure for pancreatic adenocarcinoma.