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胰十二指肠切除术后胃排空障碍相关危险因素分析 总被引:1,自引:0,他引:1
目的探讨胰十二指肠切除术后发生胃排空障碍的相关危险因素,为临床的防治提供参考。方法回顾性分析2005年1月至2013年7月间收治的120例胰头癌患者的临床资料,采用病例对照研究方法,将其中发生胃排空障碍的25例患者作为病例组,未发生胃排空障碍的95例患者作为对照组,对两组患者进行单因素分析和多因素非条件Logistic回归分析。结果单因素分析结果显示,手术后胰漏、手术方式、术后白蛋白水平、手术时间、术前总胆红素、术后血红蛋白、腹腔感染、术后输血量、术后空腹血糖、术后生长抑素例数及术前减黄与胰十二指肠切除术后胃排空障碍发生有关(P<0.05)。多因素非条件的Logistic回归分析显示,术后胰漏、手术方式、腹腔感染、术后空腹高血糖是胰十二指肠切除术后发生胃排空障碍的独立危险因素(P<0.05)。结论术后胰漏、手术方式、腹腔感染、术后空腹高血糖是胰十二指肠切除术后发生胃排空障碍的独立危险因素。 相似文献
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Background
The clinical risk factors of delayed gastric emptying (DGE) in patients after pancreaticoduodenectomy (PD) remains controversial. Herein, we conducted a systematic review to quantify the associations between clinical risk factors and DGE in patients after conventional PD or pylorus preserving pancreaticoduodenectomy (PPPD).Methods
A systematic search of electronic databases (PubMed, EMBASE, OVID, Web of Science, The Cochrane Library) for studies published from 1970 to 2012 was performed. Cohort, case–control studies, and randomized controlled trials that examined clinical risk factors of DGE were included.Results
Eighteen studies met final inclusion criteria (total n = 3579). From the pooled analyses, preoperative diabetes (OR 1.49, 95% CI, 1.03–2.17), pancreatic fistulas (OR 2.66, 95% CI, 1.65–4.28), and postoperative complications (OR 4.71, 95% CI, 2.61–8.50) were significantly associated with increased risk of DGE; while patients with preoperative biliary drainage (OR 0.68, 95% CI, 0.48–0.97) and antecolic reconstruction (OR 0.17, 95% CI, 0.07–0.41) had decreased risk of DGE development. Gender, malignant pathology, preoperative jaundice, intra-operative transfusion, PD vs. PPPD and early enteral feeding were not significantly associated with DGE development (all P > 0.05).Conclusions
Our findings demonstrate that preoperative diabetes, pancreatic fistulas, and postoperative complications were clinical risk factors predictive for DGE. Antecolic reconstruction and preoperative biliary drainage result in a reduction in DGE. Knowledge of these risk factors may assist in identification and appropriate referral of patients at risk of DGE. 相似文献3.
目的通过meta分析,探讨胰十二指肠切除术后发生胃排空延迟的影响因素及其相关危险度。方法 通过检索Cochrane Library、Medline、Pubmed、Ovid、Embase,搜集近二十年发表的关于胰十二指肠切除术后发生胃排空延迟影响因素的相关文献,进行meta分析,计算每个危险因素的优势比(OR值)及95%CI。结果 meta分析共纳入研究文献26篇,其中6篇RCTs,9篇队列研究,11篇病例对照研究。经meta分析,计算合并OR值分别为:保留幽门2.35(95% CI,0.72-7.61),术后早期肠内营养0.93(95% CI,0.64-1.35),术后腹部并发症6.14(95% CI,3.47-10.85),Billroth I式胃肠重建(与Billroth II相比)4.30(95% CI,1.00-18.43),结肠前胃肠吻合0.12(95% CI,0.05-0.27)。结论 胰十二指肠切除术后,腹部并发症是发生胃排空延迟的一个危险因素;保留幽门不增加胃排空延迟的发生率;术后早期肠内营养与胃排空延迟发生无关;结肠前及Billroth II式胃肠重建可能会降低胃排空延迟的发生率。 相似文献
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D.J. Evers R.M. SmeenkP.D. Bottenberg E.D. van WerkhovenH. Boot V.J. Verwaal 《European journal of surgical oncology》2011,37(2):162-167
Background
Delayed gastric emptying (DGE) is a main complication with unknown origin after a cytoreductive surgery and hyperthermic intra-peritoneal chemotherapy (CRS-HIPEC). The aim of this study was to investigate if preservation of the right gastro-epiploic artery (GEA) during standard omentectomy would have a positive effect on gastric emptying after CRS-HIPEC.Methods
Forty-two patients subjected to a CRS-HIPEC were randomized into two groups perioperatively before performing an omentectomy: in Group I (N = 21) omentectomy was performed with preservation of the GEA; in Group II (N = 21) omentectomy was performed with resection of the GEA. The primary endpoint was the number of days to full oral intake of solid food. Secondary endpoints were number of days to intended occlusion of gastrostomy catheter and total hospital admission time.Results
No significant differences were discovered between both groups in any of the study endpoints after CRS-HIPEC. No significant differences were observed in patient or operation characteristics between the randomized groups.Conclusions
No association was demonstrated between preservation of the gastro-epiploic artery during omentectomy and gastric emptying after CRS-HIPEC. The extensive intestinal manipulation or the heated intra-peritoneal chemotherapy during surgery are more plausible causes of this phenomenon.This clinical trial was registered in the Netherlands at the Central Committee on Research involving Human Subjects (CCMO) under registration number P06.0301L. 相似文献5.
目的 探讨食管癌切除术后胃排空障碍的原因及防治措施。方法 对食管癌术后并发胃排空障碍 17例患者的临床资料进行回顾性分析。结果 本组均发生于术后 7~ 12天 ,其中 12例功能性胃排空障碍经保守治疗 ,治愈 11例 ,死亡 1例 ,5例机械性胃排空障碍均经手术治愈 ,本组死亡率为 5 .88%。结论 迷走神经切断及胃解剖位置的变化是胃排空障碍的主要原因 ,其次胃排空障碍也与胃扭转、术后粘连等因素有关。X线钡剂造影及胃镜检查是诊断本病的主要方法。功能性胃排空障碍 ,一般行保守治疗 ;机械性胃排空障碍 ,应尽早手术。术前充分准备 ,手术操作认真、规范 ,术后恰当处理 ,可减少胃排空障碍的发生 相似文献
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目的:探讨远端胃部分切除术后胃排空延迟(DGE)发生的影响因素及对两种胃肠吻合方式的术后短期生活质量初步评价.方法:回顾性分析2013年9月至2015年6月在西安交通大学第一附属医院行远端胃部分切除术后符合纳入标准的106例患者的临床资料,探索远端胃部分切除术后DGE发生的影响因素及采用EORTC QLQ-C30对患者短期内生活质量进行评价.结果:25例患者术后发生DGE,发生率为23.58%.单因素分析结果表明,体重指数、胃肠吻合方式、术前合并糖尿病、术后下地活动时间、术后蛋白及血红蛋白水平、术后并发症与DGE的发生相关;按吻合方式进行分组,术后两组患者生活质量在功能领域和症状领域均有差异.多因素LogistiC回归分析结果表明,胃空肠吻合方式(OR=2.997,95%CI:1.010~8.896,P=0.048)、有无糖尿病史(OR=5.687,95% CI:2.004~ 16.141,P=0.001)均为远端胃切除术后DGE发生的危险因素.结论:远端胃部分切除术后DGE的发生率较高,积极的围手术期准备、治疗、科学合理的控制血糖可有效预防术后DGE的发生以及提高患者短期生活质量. 相似文献
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Background
Postoperative pancreatic fistula (PF) is the leading morbidity after pancreaticoduodenectomy (PD). The pancreatoenteric anastomosis method after PD is associated with the occurrence of PF. Evidence shows that pancreaticogastrostomy (PG) is possibly superior to pancreaticojejunostomy (PJ) in reducing the incidence of PF after PD; however, this remains to be definitively confirmed.Methods
Randomized clinical trials (RCTs) comparing the outcomes of PG versus PJ after PD were retrieved for meta-analysis.Results
After a thorough search of the English literature published until March 23rd, 2014, we identified seven RCTs involving 1095 patients (PG group, 548; PJ group, 547) for final analysis. Meta-analysis revealed that the incidence of PF was significantly lower in the PG group (15.7%) than in the PJ group (23.0%, 126/547; OR = 0.61, 95% CI: 0.45–0.83, P = 0.002). Furthermore, the incidence of intra-abdominal fluid collection was also lower in the PG group than in the PJ group (OR = 0.43, 95% CI: 0.28–0.65, P < 0.0001). No significant differences were found between the PG and PJ groups in terms of delayed gastric emptying, hemorrhage, overall morbidity and mortality.Conclusions
PG seemed to be superior to PJ in reducing the incidence of PF and intra-abdominal fluid collection after PD. 相似文献10.
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CT体积测量在进展期胃癌患者新辅助化疗疗效评价中的应用价值研究 总被引:3,自引:0,他引:3
目的探讨多层螺旋CT体积测量技术对于进展期胃癌患者新辅助化疗疗效评价的应用价值。方法对31例胃镜病理确诊胃癌的患者(男性24例,女性7例,平均年龄57岁)进行化疗前64层螺旋CT增强扫描,所有患者接受胃癌新辅助化疗(Folfox6方案)3个疗程,化疗后再行64层螺旋CT增强扫描,1周内所有患者手术切除肿瘤,并取得病理作对照,分为病理无效组和有效组。以门脉期重建图像测量肿瘤厚度及体积,分析肿瘤厚度和体积变化与病理评价疗效的关系。结果CT测量肿瘤厚度较测量肿瘤体积重复性差。CT肿瘤厚度减少率与病理分级的相关性r=0.540(P=0.002)。CT肿瘤体积减少率与病理分级的相关系数为0.570(P=0.001),呈中度相关。如果将肿瘤体积减少率37.2%作为的评价化疗有效的阈值,其预测病理评价有效的敏感性是73%,特异性80%。结论CT测量肿瘤厚度减少率和体积减少率可以帮助预测进展期胃癌患者化疗疗效,但CT肿瘤体积测量更客观,与化疗疗效的相关性更好。 相似文献
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A prospective, randomized trial of pre-operative and intraoperative radiotherapy versus surgery alone in resectable gastric cancer 总被引:3,自引:0,他引:3
V. Y. Skoropad B. A. Berdov Y. S. Mardynski L. N. Titova 《European journal of surgical oncology》2000,26(8):773-779
INTRODUCTION: Worldwide, gastric cancer remains one of the most common malignancies. Discouraging survival rates after surgical treatment promote the study of adjuvant therapy. A prospectively, randomized, controlled clinical trial was performed in order to determine whether pre-operative and intraoperative radiotherapy improves treatment results of gastrectomy for stomach carcinoma. METHODS: From 1993 to 1998, 112 patients were randomized and underwent exploratory laparotomy; among them 78 satisfied protocol requirements and entered in the trial. Patients in the experimental group were treated with pre-operative radiotherapy (20 Gy/5 days), gastrectomy and intraoperative radiotherapy (20 Gy using 8-12 electrons). Patients in the control group underwent surgery alone. RESULTS: Incidence and distribution of post-operative complications were similar in both groups except significantly higher incidence of pancreatitis after surgical treatment. No late radiation-related morbidity was registered. There was no significant difference in survival between the two treatment groups (Chi(2)=1.026, df=1, P=0. 311) as well as in N0 (Chi(2)=0.0029, df=1, P=0.956) and T1-2 subgroups (Chi(2)=0.1928, df=1, P=0.660). In contrast, combined treatment had marked survival advantage in more advanced stages: in the case of lymph-node involvement (Chi(2)=4.19, df=1, P=0.04) and extragastric tumour extension (Chi(2)=4.118, df=1, P=0.042). CONCLUSION: The proposed intensive treatment programme is feasible, shows good acute and late tolerance and has the potential to improve survival in patients with locally advanced gastric cancer. 相似文献
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Factors related to occurrence and aggravation of pancreatic fistula after radical gastrectomy for gastric cancer
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Daisuke Kobayashi MD PhD Naoki Iwata MD PhD Chie Tanaka MD PhD Mitsuro Kanda MD PhD Suguru Yamada MD PhD Goro Nakayama MD PhD Tsutomu Fujii MD PhD Masahiko Koike MD PhD Michitaka Fujiwara MD PhD Yasuhiro Kodera MD PhD 《Journal of surgical oncology》2015,112(4):381-386
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BackgroundDespite various technical modifications, delayed gastric emptying (DGE) is one of the most common complications after pancreatoduodenectomy. DGE results in longer hospital stay, higher cost, lower quality of life, and delay of adjuvant therapy. We have developed a modified duodenojejunostomy technique to reduce the incidence of DGE. Here we evaluate our 4-year experience with this technique.MethodsThis study evaluated consecutive patients who underwent pylorus-preserving pancreatoduodenectomy using the growth factor technique. It consists of performing a posterior seromuscular running suture with a zigzag stitch that stretches the jejunum and allows future growth of the anastomosis. This results in a longer jejunal opening. The angles at the edge of the duodenum are cut to accommodate the duodenal opening to the longer jejunum (the growth factor). The anterior seromuscular layer is then performed with interrupted sutures to accommodate the larger anastomosis. These patients were compared with a cohort of patients (n = 103) before the introduction of this new technique using propensity score matching.Results134 patients underwent pylorus-preserving pancreatoduodenectomy. Delayed gastric emptying occurred in only three patients (2.2%), one grade B and two grade C. Compared with the 103 patients in the control group with standard technique, the incidence of DGE was significantly higher (11.6%; P = 0.00318). The median hospital stay was also statistically longer in the control group (P = 0.048704). A similar trend was observed in the matched cohort; the proportion of patients who developed DGE was significantly (P = 0.005) lower in the growth factor technique group (2.1% vs. 12.9%). Hospital stay was significantly longer in the standard group (P = 0.008), and patients operated on with the standard technique resumed feeding later than those with the growth factor technique.ConclusionsThis study demonstrated that the new technique of duodenojejunostomy can reduce the incidence and severity of DGE and allow earlier hospital discharge. Comparative studies are still needed to confirm these preliminary results. 相似文献
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Concentrated preoperative radiotherapy for resectable gastric cancer: 20-years follow-up of a randomized trial 总被引:5,自引:0,他引:5
BACKGROUND AND OBJECTIVES: The role of radiation therapy in resectable gastric cancer is questionable. To study the value of concentrated preoperative radiotherapy, a randomized clinical trial had been carried out. METHODS: From 1974 to 1978, 152 patients were randomized and underwent exploratory laparotomy; in 50 patients curative surgery was not possible, while 102 patients satisfied protocol requirements and entered in the trial. Patients in the experimental group were treated with preoperative radiotherapy (20 Gy/5 days) and subtotal or total gastrectomy. Patients in the control group underwent surgery alone. RESULTS: Study showed acceptable tolerance of radiotherapy regime with no increase of postoperative mortality and morbidity. There was no significant difference in survival between the two treatment groups (chi 2 = 0.349, df = 1, P = 0.555). Subset analysis also failed to demonstrate significant survival advantages of the combined treatment; however, some positive trends were seen in patients with locally advanced gastric cancer. CONCLUSIONS: Concentrated preoperative radiotherapy in the dose of 20 Gy is safe and feasible, but seems to be insufficient to improve survival in gastric cancer patients. However, the results are promising in selected subgroups of patients, which encourages future trials with adjuvant radiation therapy. 相似文献
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Combination gemcitabine/cisplatin therapy and ERCC1 expression for resected pancreatic adenocarcinoma: Results of a Phase II prospective trial
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Lauren M. Postlewait MD Cecilia G. Ethun MD David A. Kooby MD Juan M. Sarmiento MD Zhengjia Chen PhD Charles A. Staley MD III Edith Brutcher NP Volkan Adsay MD Bassel El‐Rayes MD Shishir K. Maithel MD 《Journal of surgical oncology》2016,114(3):336-341
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Peigang Yang Yuan Tian Bibo Tan Pingan Ding Honghai Guo Yang Liu Zhidong Zhang Yong Li Qun Zhao 《Journal of gastrointestinal oncology.》2021,12(5):2052
BackgroundThe significance of nano-carbon for lymph node staging in radical gastrectomy for gastric cancer (GC) has been confirmed, but studies on its application for GC patients treated with neoadjuvant chemotherapy (NCT) are rare. The purpose of this study was to explore the clinical value of using carbon nanoparticles suspension injections (CNS) to improve the accuracy of lymph node staging (N staging) of NCT for advanced GC.Methods160 advanced GC patients receiving preoperative NCT were enrolled, according to the random number generated by computer, the enrolled patients were randomly divided into two groups: experimental group (n=80) and control group (n=80). The experimental group received endoscopic injection of CNS within 24 hours prior to NCT, while the control group received this within 24 hours post NCT and before D2 radical resection. SOX [oxaliplatin: 130 mg/(body surface area, BSA): m2, first day + S-1: (BSA: <1.25 m2, 40 mg each time; ≥1.25 to <1.5 m2, 50 mg each time; ≥1.5 m2, 60 mg each time), 2 times a day, for 2 weeks] was chosen as the NCT regimen, repeat every 3 weeks, 4 cycles were performed preoperative. Surgery was performed 3 weeks after the end of the 4 cycles of chemotherapy. The staining rate, metastasis rate, metastasis rate of stained lymph nodes, postoperative complication rate, and N staging of the two groups were analyzed and compared.ResultsA total of 3,197 lymph nodes were harvested in the experimental group, including 384 metastatic lymph nodes, 1,424 stained lymph nodes, and 210 metastatic stained lymph nodes. The total number of lymph nodes harvested in the control group was 2,565, including 244 metastatic lymph nodes, 796 stained lymph nodes, and 94 metastatic stained lymph nodes. Compared with the control group, a higher rate of stained lymph nodes, a higher total number of lymph nodes, and an increased number of metastatic lymph nodes were detected in the experimental group.ConclusionsThe application of CNS before NCT in patients with advanced GC can minimize lymph node staging bias after NCT and improve its accuracy.Trial RegistrationChinese Clinical Trial Registry ChiCTR2100047407. 相似文献
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