Reconstruction by pancreaticojejunostomy versus pancreaticogastrostomy following pancreatectorny results of a comparative study
Reconstruction by pancreaticojejunostomy versus pancreaticogastrostomy following pancreatectorny results of a comparative study
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DOI：
10.1097/01.sla.0000189124.47589.6d
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发表时间：
2005-12-01
影响因子：
9
通讯作者：
Pederzoli, P
中科院分区：
文献类型：
--
作者：
Bassi, C;Falconi, M;Pederzoli, P
目的：在前瞻性随机研究中比较胰管切除术后胰胃吻合术与胰肠吻合术的结果。摘要背景资料：虽然已经提出了几种重建胰消化道连续性的技术，但只有有限数量的随机研究已经进行。方法：共有151例接受胰管切除术的软残留组织患者随机接受胰胃吻合术，PG组行胰管空肠端侧吻合术。结果：两个治疗组在生命统计数据或基础疾病、平均手术持续时间和术中输血需求方面无差异。总体而言，手术并发症的发生率为34%（PG为29%，PJ为39%，P =不显著）。接受PG治疗的患者显示多种手术并发症的发生率显著降低（P = 0.002）。胰瘘是最常见的并发症，发生在14.5%的患者中（PG为13%，PJ为16%，P =不显著）。每个治疗组中有5例患者需要二次手术干预;术后死亡率为0.6%。PG优于PJ，因为在术后收集（P = 0.01）、胃排空延迟（P = 0.03）和胆瘘（P = 0.01）方面存在显著差异。平均术后住院时间在两组之间具有可比性。结论：与PJ相比，PG在总体术后并发症发生率或胰瘘发生率方面没有表现出任何显著差异。然而，胆瘘，术后收集和胃排空延迟的PG治疗的患者显着减少。此外，胰胃切开术是与一个显着降低频率的多种手术并发症。
Objective: To compare the results of pancreaticogastrostomy versus pancreaticojejunostomy following pancreaticoduodenectomy in a prospective and randomized setting.Summary Background Data: While several techniques have been proposed for reconstructing pancreatico-digestive continuity, only a limited number of randomized studies have been carried out.Methods: A total of 151 patients undergoing pancreaticoduodenectomy with soft residual tissue were randomized to receive either pancreaticogastrostomy (group PG) or end-to-side pancreaticojejunostomy. (group PJ).Results: The 2 treatment groups showed no differences in vital statistics or underlying disease, mean duration of surgery, and need for intraoperative blood transfusion. Overall, the incidence of surgical complications was 34% (29% in PG, 39% in PJ, P = not significant). Patients receiving PG showed a significantly lower rate of multiple surgical complications (P = 0.002). Pancreatic fistula was the most frequent complication, occurring in 14.5% of patients (13% in PG and 16% in PJ, P = not significant). Five patients in each treatment arm required a second surgical intervention; the postoperative mortality rate was 0.6%. PG was favored over PJ due to significant differences in postoperative collections (P = 0.01), delayed gastric emptying (P = 0.03), and biliary fistula (P = 0.01). The mean postoperative hospitalization period stay was comparable in both groups.Conclusions: When compared with PJ, PG did not show any significant differences in the overall postoperative complication rate or incidence of pancreatic fistula. However, biliary fistula, postoperative collections and delayed gastric emptying are significantly reduced in patients treated by PG. In addition, pancreaticogastrotomy is associated with a significantly lower frequency of multiple surgical complications.