• 中國(guó)醫(yī)科大學(xué)附屬盛京醫(yī)院乳腺外科(沈陽(yáng) 110004);

目的 研究影響保留幽門的胰十二指腸切除術(shù)(PPPD)后功能性胃排空障礙(FDGE)的危險(xiǎn)因素及預(yù)防。
方法 對(duì)我院2003~2009年期間41例行PPPD患者的臨床資料進(jìn)行回顧性分析。
結(jié)果 41例患者中有13例(31.7%)術(shù)后發(fā)生并發(fā)癥，其中并發(fā)FDGE者有7例(17.1%)。單因素分析得出FDGE的發(fā)生與糖尿病(P=0.024)及術(shù)后其他并發(fā)癥(P=0.010)有關(guān)，F(xiàn)DGE組患者與未發(fā)生FDGE組患者相比，術(shù)前白蛋白水平明顯下降(P=0.020),血直接膽紅素明顯升高(P=0.036)，而通過二分類logistic回歸分析得出FDGE的發(fā)生僅與白蛋白水平(P=0.039)及伴有糖尿病(P=0.047)有關(guān)。
結(jié)論 在PPPD后的患者中，術(shù)前積極控制血糖、糾正低蛋白血癥、高膽紅素血癥及在大規(guī)模醫(yī)療中心集中進(jìn)行PPPD對(duì)預(yù)防FDGE的發(fā)生可能有積極意義。

引用本文： 潘春來,何貴金,顧璽,趙曉丹,康瑜,王柳. 保留幽門的胰十二指腸切除術(shù)后功能性胃排空障礙的危險(xiǎn)因素分析. 中國(guó)普外基礎(chǔ)與臨床雜志, 2010, 17(9): 959-962. doi: 復(fù)制

1. Yeo CJ, Barry MK, Sauter PK, et al. Erythromycin accelerates gastric emptying after pancreaticoduodenectomy. A prospective, randomized, placebocontrolled trial [J]. Ann Surg, 1993; 218(3): 229237.
2. Traverso LW, Longmire WP Jr. Preservation of the pylorus in pancreaticoduodenectomy a followup evaluation [J]. Ann Surg, 1980; 192(3): 306310.
3. Fabre JM, Burgel JS, Navarro F, et al. Delayed gastric emptying after pancreaticoduodenectomy and pancreaticogastrostomy [J]. Eur J Surg, 1999; 165(6): 560565.
4. Bu XM, Xu J, Dai XW, et al. Is delayed gastric emptying so terrible after pyloruspreserving pancreaticoduodenectomy? Prevention and management [J]. World J Gastroenterol, 2006; 12(39): 63826385.
5. Riediger H, Makowiec F, Schareck WD, et al. Delayed gastric emptying after pyloruspreserving pancreatoduodenectomy is strongly related to other postoperative complications [J]. J Gastrointest Surg, 2003; 7(6): 758765.
6. Maes BD, Vanwalleghem J, Kuypers D, et al. Differences in gastric motor activity in renal transplant recipients treated with FK506 versus cyclosporine [J]. Transplantation, 1999; 68(10): 14821485.
7. Horowitz M, Fraser RJ. Gastroparesis: diagnosis and management [J]. Scand J Gastroenterol Suppl, 1995; 213: 716.
8. Shafi MA, Pasricha PJ. Postsurgical and obstructive gastroparesis [J]. Curr Gastroenterol Rep, 2007; 9(4): 280285.
9. Ishiguchi T, Tada H, Nakagawa K, et al. Hyperglycemia impairs antropyloric coordination and delays gastric emptying in conscious rats [J]. Auton Neurosci, 2002; 95(12): 112120.
10. 秦新裕, 劉鳳林. 重視腹部手術(shù)后消化道功能障礙的診治 [J]. 中國(guó)實(shí)用外科雜志, 2003; 23(8): 449.
11. Schmidt CM, Powell ES, Yiannoutsos CT, et al. Pancreaticoduodenectomy: a 20year experience in 516 patients [J]. Arch Surg, 2004; 139(7): 718725.
12. Tani M, Terasawa H, Kawai M, et al. Improvement of delayed gastric emptying in pyloruspreserving pancreaticoduodenectomy: results of a prospective, randomized, controlled trial [J]. Ann Surg, 2006; 243(3): 316320.
13. Yeo CJ, Cameron JL, Sohn TA, et al. Pancreaticoduodenectomy with or without extended retroperitoneal lymphadenectomy for periampullary adenocarcinoma: comparison of morbidity and mortality and shortterm outcome [J]. Ann Surg, 1999; 229(5): 613622.
14. Yeo CJ, Cameron JL, Lillemoe KD, et al. Pancreaticoduodenectomy with or without distal gastrectomy and extended retroperitoneal lymphadenectomy for periampullary adenocarcinoma, part 2: randomized controlled trial evaluating survival, morbidity, and mortality [J]. Ann Surg, 2002; 236(3): 355366.
15. Shone DN, Nikoomanesh P, SmithMeek MM, et al. Malignancy is the most common cause of gastric outlet obstruction in the era of H2 blockers [J]. Am J Gastroenterol, 1995; 90(10): 17691770.
16. 馬凱， 李延均. 胰十二指腸切除術(shù)中引流管的放置與術(shù)后管理(附88例報(bào)告) [J]. 中國(guó)普外基礎(chǔ)與臨床雜志， 2000; 7(6): 393394.
17. 郭志義， 龐明輝. 腹部手術(shù)后功能性胃排空障礙的營(yíng)養(yǎng)支持 [J]. 中國(guó)普外基礎(chǔ)與臨床雜志， 2005; 12(5): 506507.
18. 黎介壽． 腸內(nèi)營(yíng)養(yǎng)—外科臨床營(yíng)養(yǎng)支持的首選途徑 [J]．中國(guó)實(shí)用外科雜志， 2003; 23(2)： 67．.
  1. 1. Yeo CJ, Barry MK, Sauter PK, et al. Erythromycin accelerates gastric emptying after pancreaticoduodenectomy. A prospective, randomized, placebocontrolled trial [J]. Ann Surg, 1993; 218(3): 229237.
  2. 2. Traverso LW, Longmire WP Jr. Preservation of the pylorus in pancreaticoduodenectomy a followup evaluation [J]. Ann Surg, 1980; 192(3): 306310.
  3. 3. Fabre JM, Burgel JS, Navarro F, et al. Delayed gastric emptying after pancreaticoduodenectomy and pancreaticogastrostomy [J]. Eur J Surg, 1999; 165(6): 560565.
  4. 4. Bu XM, Xu J, Dai XW, et al. Is delayed gastric emptying so terrible after pyloruspreserving pancreaticoduodenectomy? Prevention and management [J]. World J Gastroenterol, 2006; 12(39): 63826385.
  5. 5. Riediger H, Makowiec F, Schareck WD, et al. Delayed gastric emptying after pyloruspreserving pancreatoduodenectomy is strongly related to other postoperative complications [J]. J Gastrointest Surg, 2003; 7(6): 758765.
  6. 6. Maes BD, Vanwalleghem J, Kuypers D, et al. Differences in gastric motor activity in renal transplant recipients treated with FK506 versus cyclosporine [J]. Transplantation, 1999; 68(10): 14821485.
  7. 7. Horowitz M, Fraser RJ. Gastroparesis: diagnosis and management [J]. Scand J Gastroenterol Suppl, 1995; 213: 716.
  8. 8. Shafi MA, Pasricha PJ. Postsurgical and obstructive gastroparesis [J]. Curr Gastroenterol Rep, 2007; 9(4): 280285.
  9. 9. Ishiguchi T, Tada H, Nakagawa K, et al. Hyperglycemia impairs antropyloric coordination and delays gastric emptying in conscious rats [J]. Auton Neurosci, 2002; 95(12): 112120.
  10. 10. 秦新裕, 劉鳳林. 重視腹部手術(shù)后消化道功能障礙的診治 [J]. 中國(guó)實(shí)用外科雜志, 2003; 23(8): 449.
  11. 11. Schmidt CM, Powell ES, Yiannoutsos CT, et al. Pancreaticoduodenectomy: a 20year experience in 516 patients [J]. Arch Surg, 2004; 139(7): 718725.
  12. 12. Tani M, Terasawa H, Kawai M, et al. Improvement of delayed gastric emptying in pyloruspreserving pancreaticoduodenectomy: results of a prospective, randomized, controlled trial [J]. Ann Surg, 2006; 243(3): 316320.
  13. 13. Yeo CJ, Cameron JL, Sohn TA, et al. Pancreaticoduodenectomy with or without extended retroperitoneal lymphadenectomy for periampullary adenocarcinoma: comparison of morbidity and mortality and shortterm outcome [J]. Ann Surg, 1999; 229(5): 613622.
  14. 14. Yeo CJ, Cameron JL, Lillemoe KD, et al. Pancreaticoduodenectomy with or without distal gastrectomy and extended retroperitoneal lymphadenectomy for periampullary adenocarcinoma, part 2: randomized controlled trial evaluating survival, morbidity, and mortality [J]. Ann Surg, 2002; 236(3): 355366.
  15. 15. Shone DN, Nikoomanesh P, SmithMeek MM, et al. Malignancy is the most common cause of gastric outlet obstruction in the era of H2 blockers [J]. Am J Gastroenterol, 1995; 90(10): 17691770.
  16. 16. 馬凱， 李延均. 胰十二指腸切除術(shù)中引流管的放置與術(shù)后管理(附88例報(bào)告) [J]. 中國(guó)普外基礎(chǔ)與臨床雜志， 2000; 7(6): 393394.
  17. 17. 郭志義， 龐明輝. 腹部手術(shù)后功能性胃排空障礙的營(yíng)養(yǎng)支持 [J]. 中國(guó)普外基礎(chǔ)與臨床雜志， 2005; 12(5): 506507.
  18. 18. 黎介壽． 腸內(nèi)營(yíng)養(yǎng)—外科臨床營(yíng)養(yǎng)支持的首選途徑 [J]．中國(guó)實(shí)用外科雜志， 2003; 23(2)： 67．.