Pylorus-Resecting Pancreaticoduodenectomy Offers Long-Term Outcomes Similar to Those of Pylorus-Preserving Pancreaticoduodenectomy: Results of a Prospective Study
Pylorus-Resecting Pancreaticoduodenectomy Offers Long-Term Outcomes Similar to Those of Pylorus-Preserving Pancreaticoduodenectomy: Results of a Prospective Study
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DOI：
10.1007/s00268-013-2420-z
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发表时间：
2014-06-01
影响因子：
2.6
通讯作者：
Yamaue, Hiroki
中科院分区：
文献类型：
--
作者：
Kawai, Manabu;Tani, Masaji;Yamaue, Hiroki
我们在先前的研究中表明，与保留幽门的胰十二指肠切除术（PpPD）相比，幽门切除胰十二指肠切除术（PrPD）（在幽门环附近分割胃）保留了95%以上的胃，并显著降低了胃排空延迟（DGE）的发生率。然而，PrPD的长期结局以及术后早期DGE对长期结局的不良影响尚不清楚。术后24个月体重减轻> 2级（不良事件通用术语标准，版本4.03），PrPD组（16.2%）明显优于PpPD组（42.2%）（p = 0.011）。两组的营养状况和术后晚期并发症相似。24个月时体重减轻> 2级的发生率在DGE患者中为63.6%，在非DGE患者中为25.3%（p = 0.010）。与非DGE患者相比，DGE患者24个月时的T（max）（C-13-乙酸呼气试验中达到（CO2）-C-13含量峰值的时间）显著延迟（27.9 +/- A 22.7 vs. 16.5 +/- A 10.1 min，p = 0.023）。非DGE患者24个月时的血清白蛋白水平高于DGE患者（3.7 +/- A 0.6 vs. 4.1 +/- A 0.4 g/dl，p = 0.013）。DGE可能与患者的体重减轻和营养状况不良有关，具有长期结局。
We showed in a previous study that pylorus-resecting pancreaticoduodenectomy (PrPD), which divides the stomach adjacent to the pylorus ring, preserves more than 95 % of the stomach and significantly reduced the incidence of delayed gastric emptying (DGE) compared with pylorus-preserving pancreaticoduodenectomy (PpPD). However, long-term outcomes of PrPD and the adverse effect of early postoperative DGE on long-term outcomes remain unclear.A total of 130 patients enrolled in a previous study were followed for 24 months after surgery. Primary endpoint was whether PrPD is a better surgical procedure than PpPD regarding long-term outcomes.Weight loss > grade 2 (Common Terminology Criteria for Adverse Events, Version 4.03) at 24 months after surgery was significantly better in group PrPD (16.2 %) than in group PpPD (42.2 %) (p = 0.011). Nutritional status and late postoperative complications were similar for the two groups. The incidence of weight loss > grade 2 at 24 months was 63.6 % in DGE patients with DGE and 25.3 % in non-DGE patients (p = 0.010). T (max) (time to peak (CO2)-C-13 content in C-13-acetate breath test) at 24 months in DGE patients was significantly delayed compared with that in non-DGE patients (27.9 +/- A 22.7 vs. 16.5 +/- A 10.1 min, p = 0.023). Serum albumin level at 24 months was higher in non-DGE patients than in those with DGE (3.7 +/- A 0.6 vs. 4.1 +/- A 0.4 g/dl, p = 0.013).PrPD offers long-term outcomes similar to those of PpPD. DGE may be associated with weight loss and poor nutritional status in patients with long-term outcomes.