Prospective randomized controlled study of gastric emptying assessed by 13C-acetate breath test after pylorus-preserving pancreaticoduodenectomy: comparison between antecolic and vertical retrocolic duodenojejunostomy
Prospective randomized controlled study of gastric emptying assessed by 13C-acetate breath test after pylorus-preserving pancreaticoduodenectomy: comparison between antecolic and vertical retrocolic duodenojejunostomy
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DOI：
10.1007/s00534-008-0004-3
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发表时间：
2009-01-01
期刊：
影响因子：
--
通讯作者：
Kondo, Kazuhiro
中科院分区：
文献类型：
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作者：
Chijiiwa, Kazuo;Imamura, Naoya;Kondo, Kazuhiro
在2005年3月至2007年7月期间，对35例接受保留幽门胰十二指肠切除术（PPPD）的患者进行了前瞻性、随机、对照研究，以检查结肠后十二指肠空肠垂直吻合术在胃排空方面是否上级结肠前十二指肠空肠吻合术。所有患者均提供知情同意书。在PpPD期间，患者在重建前被随机分配到结肠前（结肠前组，n = 17）或垂直结肠后路径（垂直结肠后组，n = 18）。每例患者在手术前和术后第30天（POD）在液体餐中摄入C-13-乙酸酯。胃排空变量临床胃排空延迟是指患者在术后14天内不能进食适量固体食物，结肠前组1/17例（6%），垂直结肠后组4/18例（22%），但差异无统计学意义（P = 0.34）。术后第30天两组的Tmax和T1/2均较术前延长，但两组间无显著差异。随访检查显示，无论重建途径如何，约80%的患者在术后30天胃排空恢复到术前水平。垂直结肠后十二指肠空肠吻合术似乎在胃排空方面没有优势。
To examine whether vertical retrocolic duodenojejunostomy is superior to antecolic duodenojejunostomy with respect to gastric emptying in a prospective, randomized, controlled study of patients undergoing pylorus-preserving pancreaticoduodenectomy (PpPD).Thirty-five patients undergoing PpPD between March 2005 and July 2007 were enrolled in the study. All provided informed consent. During PpPD, the patients were randomly assigned to either the antecolic (antecolic group, n = 17) or vertical retrocolic route (vertical retrocolic group, n = 18) just before the reconstruction. Each patient ingested C-13-acetate in a liquid meal before surgery and on postoperative day (POD) 30. Gastric emptying variables (Tmax, T1/2) were determined and compared between groups.Clinical delayed gastric emptying, defined as an inability of patients to take in an appropriate amount of solid food orally by POD 14, was found in 1 of 17 patients (6%) in the antecolic group and in 4 of 18 patients (22%) in the vertical retrocolic group, but the difference was not significant (P = 0.34). Tmax and T1/2 on POD 30 were prolonged in both groups in comparison to preoperative levels, but no significant difference was found between the two groups. Follow-up examinations revealed that gastric emptying had recovered to the preoperative level by POD 30 in approximately 80% of the patients, regardless of the reconstruction route.Vertical retrocolic duodenojejunostomy does not seem to offer an advantage with respect to gastric emptying.