胆胰分离式Roux-en-Y消化道重建对胰十二指肠切除术后胃排空延迟的影响

Impact of Roux-en-Y reconstruction with isolated pancreatic drainage on delayed gastric emptying after pancreaticoduodenectomy

目的探讨胆胰分离式Roux-en-Y消化道重建(RYR)对胰十二指肠切除术(PD)后胃排空延迟(DGE)的影响。方法回顾性分析2014年1月至2020年6月在首都医科大学附属北京朝阳医院西院、朝阳市中心医院、朝阳市第二医院、日照市中心医院及滨州市第二人民医院接受PD治疗的203例患者的临床资料。根据消化道重建方式,分为RYR组(n=88)和传统单肠袢消化道重建(CLR)组(n=115)。对比两组患者DGE发生率及严重程度的差异,探究PD术后临床相关DGE(CR-DGE)发生的危险因素。结果203例患者中,男性124例,女性79例,年龄(61.6±10.2)岁,DEG总体发生率为27.6%(56/203)。RYR组CR-DGE发生率显著低于CLR组[13.6%(12/88)比26.1%(30/115),P=0.030]。年龄>65岁(OR=2.966,95%CI:1.269~6.930,P=0.012)、临床相关胰瘘(OR=3.041,95%CI:1.122~8.238,P=0.029)、腹腔积液及感染(OR=10.000,95%CI:2.552~39.184,P=0.001)、CLR(OR=3.206,95%CI:1.162~8.842,P=0.024)是PD术后CR-DGE的独立危险因素。CR-DGE患者的住院时间及住院费用均显著增加(P<0.05)。结论对于年龄>65岁、术后出现临床相关胰瘘、腹腔积液及感染的患者,应警惕CR-DGE的发生,早期给予临床干预。RYR可以降低PD术后CR-DGE的发生率。

Objective To study the impact of Roux-en-Y reconstruction with isolated pancreatic drainage(RYR)on delayed gastric emptying(DGE)after pancreaticoduodenectomy(PD).Methods The data of 203 patients who underwent PD at 5 clinical centers from January 2014 to June 2020 were collected.According to the method of reconstruction of the digestive tract,the patients were divided into the RYR group(n=88)and the conventional loop reconstruction(CLR)group(n=115).The incidence and severity of DGE were compared between groups.The risk factors of clinically relevant DGE(CR-DGE)after PD were analysed by univariate and multivariate analyses.Results Of 203 patients,there were 124 males and 79 females,aged(61.6±10.2)years.The overall incidence of DEG was 27.6%(56/203).The incidence of CR-DGE in the RYR group was significantly lower than that in the CLR group[13.6%(12/88)vs 26.1%(30/115),P=0.030].Patient age of more than 65 years(OR=2.966,95%CI:1.162-8.842,P=0.024),clinically relevant pancreatic fistula(OR=3.041,95%CI:1.122-8.238,P=0.029),ascites and abdominal infection(OR=10.000,95%CI:2.552-39.184,P=0.001),and CLR(OR=3.206,95%CI:1.162-8.842,P=0.024)were identified as independent risk factors for CR-DGE.The duration of hospitalization and hospital expenditure of patients were significantly increased in the CR-DGE group(P<0.05).Conclusions Patients over 65 years with clinically relevant pancreatic fistula,with ascites or abdominal infection after operation,had a higher evidence of CR-DGE.Roux-en-Y reconstruction with isolated pancreatic could helped to decrease the incidence of CR-DGE after PD.