胰十二指肠切除术后胃排空延迟的发病机制及危险因素

王哲; 吕行; 于家傲; 孙晓东; 李婷; 吕国悦

doi:10.3969/j.issn.1001-5256.2023.02.036

胰十二指肠切除术后胃排空延迟的发病机制及危险因素

DOI: 10.3969/j.issn.1001-5256.2023.02.036

吉林大学第一医院肝胆胰外一科，长春 130021

基金项目:

国家自然科学基金 (U20A20360);

吉林省科技厅项目 (20200603001SF)

利益冲突声明：所有作者均声明不存在利益冲突

作者贡献声明：王哲、吕行负责相关文献资料的收集及分析，论文初稿的写作；于家傲、孙晓东、李婷负责相关文献资料的分析，文章的修改；吕国悦负责拟定写作思路，指导撰写文章并最终定稿。

详细信息

通信作者:
吕国悦，lvgy@jlu.edu.cn (ORCID: 0000-0002-9778-5080)

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出版历程
- 收稿日期: 2022-07-25
- 录用日期: 2022-10-08
- 出版日期: 2023-02-20

Pathogenesis of delayed gastric emptying after pancreaticoduodenectomy and related risk factors

First Department of Hepatopancreatobiliary Surgery, The First Hospital of Jilin University, Changchun 130021, China

Research funding:

National Natural Science Foundation of China (U20A20360);

Science and Technology Department of Jilin Province (20200603001SF)

More Information

Corresponding author: LYU Guoyue, lvgy@jlu.edu.cn (ORCID: 0000-0002-9778-5080)

摘要

摘要: 胃排空延迟(DGE)为胰十二指肠切除术(PD)后常见并发症, 其发病原因与机制目前国内外尚未完全阐明, 但绝大多数患者可在一般对症治疗后痊愈。笔者对PD术后DGE发生的危险因素及病理生理机制进行综述, 旨在为临床有效防治PD术后DGE提供参考。
- 胰十二指肠切除术 /
- 胃排空 /
- 胃肌轻瘫
Abstract: Delayed gastric emptying (DGE) is a common complication after pancreaticoduodenectomy (PD). The etiology and pathogenesis of DGE have not been fully elucidated in China and globally, and the majority of patients can be cured after general symptomatic treatment. This article reviews the risk factors and pathophysiological mechanisms of DGE after PD, in order to provide a reference for the effective management of DGE after PD in clinical practice.
- Pancreaticoduodenectomy /
- Gastric Emptying /
- Gastroparesis

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参考文献(40)

[1]	PANWAR R, PAL S. The International Study Group of Pancreatic Surgery definition of delayed gastric emptying and the effects of various surgical modifications on the occurrence of delayed gastric emptying after pancreatoduodenectomy[J]. Hepatobiliary Pancreat Dis Int, 2017, 16(4): 353-363. DOI: 10.1016/S1499-3872(17)60037-7.
[2]	WENTE MN, BASSI C, DERVENIS C, et al. Delayed gastric emptying (DGE) after pancreatic surgery: a suggested definition by the International Study Group of Pancreatic Surgery (ISGPS)[J]. Surgery, 2007, 142(5): 761-768. DOI: 10.1016/j.surg.2007.05.005.
[3]	KIM DK, HINDENBURG AA, SHARMA SK, et al. Is pylorospasm a cause of delayed gastric emptying after pylorus-preserving pancreaticoduodenectomy?[J]. Ann Surg Oncol, 2005, 12(3): 222-227. DOI: 10.1245/ASO.2005.03.078.
[4]	ZHOU Z, PAN GD, LIU Z, et al. Application value of P-loop digestive tract reconstruction in pancreaticoduodenectomy[J]. Chin J Dig Surg, 2021, 20(10): 1085-1090. DOI: 10.3760/cma.j.cn115610-20210927-00482. 周峥, 潘光栋, 刘振, 等. P襻消化道重建在胰十二指肠切除术中的应用价值[J]. 中华消化外科杂志, 2021, 20(10): 1085-1090. DOI: 10.3760/cma.j.cn115610-20210927-00482.
[5]	QIN XY, LIU FL. The pathogenesis and treatments of postsurgical gastroparesis syndrome[J]. J Diagn Concepts Pract, 2006, 5(1): 13-15. DOI: 10.3969/j.issn.1671-2870.2006.01.005. 秦新裕, 刘凤林. 术后胃瘫综合征的发病机制和治疗[J]. 诊断学理论与实践, 2006, 5(1): 13-15. DOI: 10.3969/j.issn.1671-2870.2006.01.005.
[6]	CHEN JD, CHENG JF. Updates on pathophysiology and treatment of functional dyspepsia and gastroparesis[J]. Chin J Dig, 2021, 41(1): 3-15. DOI: 10.3760/cma.j.cn311367-20201027-00634. 陈建德, 成家飞. 功能性消化不良和胃轻瘫的病理生理学和治疗新进展[J]. 中华消化杂志, 2021, 41(1): 3-15. DOI: 10.3760/cma.j.cn311367-20201027-00634.
[7]	HALLAND M, BHARUCHA AE. Relationship between control of glycemia and gastric emptying disturbances in diabetes mellitus[J]. Clin Gastroenterol Hepatol, 2016, 14(7): 929-936. DOI: 10.1016/j.cgh.2015.11.021.
[8]	CHEN XD, MAO CC, ZHANG WT, et al. A quantified risk-scoring system and rating model for postsurgical gastroparesis syndrome in gastric cancer patients[J]. J Surg Oncol, 2017, 116(4): 533-544. DOI: 10.1002/jso.24691.
[9]	ARANGO NP, PRAKASH LR, CHIANG YJ, et al. Risk-stratified pancreatectomy clinical pathway implementation and delayed gastric emptying[J]. J Gastrointest Surg, 2021, 25(9): 2221-2230. DOI: 10.1007/s11605-020-04877-z.
[10]	LEE SH, LEE YH, HUR YH, et al. A comparative study of postoperative outcomes after stapled versus handsewn gastrojejunal anastomosis for pylorus-resecting pancreaticoduodenectomy[J]. Ann Hepatobiliary Pancreat Surg, 2021, 25(1): 84-89. DOI: 10.14701/ahbps.2021.25.1.84.
[11]	INOUE Y, SAIURA A, YOSHIOKA R, et al. Pancreatoduodenectomy with systematic mesopancreas dissection using a supracolic anterior artery-first approach[J]. Ann Surg, 2015, 262(6): 1092-1101. DOI: 10.1097/SLA.0000000000001065.
[12]	TANAKA M, HECKLER M, MIHALJEVIC AL, et al. Meta-analysis of effect of routine enteral nutrition on postoperative outcomes after pancreatoduodenectomy[J]. Br J Surg, 2019, 106(9): 1138-1146. DOI: 10.1002/bjs.11217.
[13]	MATSUMOTO I, SHINZEKI M, ASARI S, et al. A prospective randomized comparison between pylorus- and subtotal stomach-preserving pancreatoduodenectomy on postoperative delayed gastric emptying occurrence and long-term nutritional status[J]. J Surg Oncol, 2014, 109(7): 690-696. DOI: 10.1002/jso.23566.
[14]	LI GY, PENG Y, MA H, et al. Comprehensive treatment on gastroparesis syndrome after pancreatoduodenectomy[J]. J Hepatopancreatobiliary Surg, 2017, 29(4): 308-310. DOI: 10.11952/j.issn.1007-1954.2017.04.011. 黎官印, 彭勇, 马海, 等. 胰十二指肠切除术后胃瘫综合征的综合治疗[J]. 肝胆胰外科杂志, 2017, 29(4): 308-310. DOI: 10.11952/j.issn.1007-1954.2017.04.011.
[15]	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. DOI: 10.1097/01.sla.0000201479.84934.ca.
[16]	GAO W, LI T, XI R, et al. Effect of different anastomotic methods on gastric emptying disorder after pancreaticoduodenectomy[J]. J Reg Anat Oper Surg, 2020, 29(6): 501-504. DOI: 10.11659/jjssx.02E020021.
[17]	ESHUIS WJ, van DALEN JW, BUSCH OR, et al. Route of gastroenteric reconstruction in pancreatoduodenectomy and delayed gastric emptying[J]. HPB (Oxford), 2012, 14(1): 54-59. DOI: 10.1111/j.1477-2574.2011.00403.x.
[18]	MENG H, ZHOU D, JIANG X, et al. Incidence and risk factors for postsurgical gastroparesis syndrome after laparoscopic and open radical gastrectomy[J]. World J Surg Oncol, 2013, 11: 144. DOI: 10.1186/1477-7819-11-144.
[19]	XU B, ZHU YH, QIAN MP, et al. Braun enteroenterostomy following pancreaticoduodenectomy: A systematic review and meta-analysis[J]. Medicine (Baltimore), 2015, 94(32): e1254. DOI: 10.1097/MD.0000000000001254.
[20]	KOBAYASHI S, KOIZUMI S, HATORI T, et al. The vertical array reconstruction technique in pylorus-preserving pancreatoduodenectomy[J]. Dig Surg, 2018, 35(5): 469-473. DOI: 10.1159/000485847.
[21]	DIENER MK, FITZMAURICE C, SCHWARZER G, et al. Pylorus-preserving pancreaticoduodenectomy (pp Whipple) versus pancreaticoduodenectomy (classic Whipple) for surgical treatment of periampullary and pancreatic carcinoma[J]. Cochrane Database Syst Rev, 2014, 11(11): CD006053. DOI: 10.1002/14651858.CD006053.pub5.
[22]	PODDA M, GERARDI C, DI SAVERIO S, et al. Robotic-assisted versus open pancreaticoduodenectomy for patients with benign and malignant periampullary disease: a systematic review and meta-analysis of short-term outcomes[J]. Surg Endosc, 2020, 34(6): 2390-2409. DOI: 10.1007/s00464-020-07460-4.
[23]	SHYR BU, SHYR BS, CHEN SC, et al. Mesopancreas level 3 dissection in robotic pancreaticoduodenectomy[J]. Surgery, 2021, 169(2): 362-368. DOI: 10.1016/j.surg.2020.07.042.
[24]	ZHANG J, WU WM, YOU L, et al. Robotic versus open pancreatectomy: a systematic review and meta-analysis[J]. Ann Surg Oncol, 2013, 20(6): 1774-80. DOI: 10.1245/s10434-012-2823-3.
[25]	NICKEL F, HANEY CM, KOWALEWSKI KF, et al. Laparoscopic versus open pancreaticoduodenectomy: A systematic review and meta-analysis of randomized controlled trials[J]. Ann Surg, 2020, 271(1): 54-66. DOI: 10.1097/SLA.0000000000003309.
[26]	van HILST J, de ROOIJ T, BOSSCHA K, et al. Laparoscopic versus open pancreatoduodenectomy for pancreatic or periampullary tumours (LEOPARD-2): a multicentre, patient-blinded, randomised controlled phase 2/3 trial[J]. Lancet Gastroenterol Hepatol, 2019, 4(3): 199-207. DOI: 10.1016/S2468-1253(21)00054-6.
[27]	SUN XQ, WANG LC, XIA QQ, et al. Short-term outcomes of laparoscopic pancreaticoduodenectomy versus open pancreaticoduodenectomy[J]. Chin J Gen Surg, 2020, 35(9): 685-688. DOI: 10.3760/cma.j.cn113855-20191205-00714. 孙筱强, 王连才, 夏强强, 等. 腹腔镜与开腹胰十二指肠切除术的短期效果对比[J]. 中华普通外科杂志, 2020, 35(9): 685-688. DOI: 10.3760/cma.j.cn113855-20191205-00714.
[28]	OHWADA S, SATOH Y, KAWATE S, et al. Low-dose erythromycin reduces delayed gastric emptying and improves gastric motility after Billroth I pylorus-preserving pancreaticoduodenectomy[J]. Ann Surg, 2001, 234(5): 668-674. DOI: 10.1097/00000658-200111000-00013.
[29]	PEDRAZZOLI S, DICARLO V, DIONIGI R, et al. Standard versus extended lymphadenectomy associated with pancreatoduodenectomy in the surgical treatment of adenocarcinoma of the head of the pancreas: a multicenter, prospective, randomized study. Lymphadenectomy Study Group[J]. Ann Surg, 1998, 228(4): 508-517. DOI: 10.1097/00000658-199810000-00007.
[30]	HUANG W, XIONG JJ, WAN MH, et al. Meta-analysis of subtotal stomach-preserving pancreaticoduodenectomy vs pylorus preserving pancreaticoduodenectomy[J]. World J Gastroenterol, 2015, 21(20): 6361-6373. DOI: 10.3748/wjg.v21.i20.6361.
[31]	SULLIVAN A, TEMPERLEY L, RUBAN A. Pathophysiology, aetiology and treatment of gastroparesis[J]. Dig Dis Sci, 2020, 65(6): 1615-1631. DOI: 10.1007/s10620-020-06287-2.
[32]	HAYAMA S, SENMARU N, HIRANO S. Delayed gastric emptying after pancreatoduodenectomy: comparison between invaginated pancreatogastrostomy and pancreatojejunostomy[J]. BMC Surg, 2020, 20(1): 60. DOI: 10.1186/s12893-020-00707-w.
[33]	QU H, SUN GR, ZHOU SQ, et al. Clinical risk factors of delayed gastric emptying in patients after pancreaticoduodenectomy: a systematic review and meta-analysis[J]. Eur J Surg Oncol, 2013, 39(3): 213-223. DOI: 10.1016/j.ejso.2012.12.010.
[34]	LASSEN K, COOLSEN MM, SLIM K, et al. Guidelines for perioperative care for pancreaticoduodenectomy: Enhanced Recovery After Surgery (ERAS^®) Society recommendations[J]. World J Surg, 2013, 37(2): 240-258. DOI: 10.1007/s00268-012-1771-1.
[35]	KAWAIDA H, KONO H, HOSOMURA N, et al. Surgical techniques and postoperative management to prevent postoperative pancreatic fistula after pancreatic surgery[J]. World J Gastroenterol, 2019, 25(28): 3722-3737. DOI: 10.3748/wjg.v25.i28.3722.
[36]	WANG H, JIN G, ZHEN KL, et al. Analysis of risk factors for delayed gastric emptying following pancreaticoduodenectomy[J]. Chin J Pancreatol, 2020, 20(2): 127-131. DOI: 10.3760/cma.j.cn115667-20191224-00119. 王欢, 金钢, 郑楷炼, 等. 胰十二指肠切除术后并发胃排空延迟的危险因素分析[J]. 中华胰腺病杂志, 2020, 20(2): 127-131. DOI: 10.3760/cma.j.cn115667-20191224-00119.
[37]	ZHU L, YANG XL, LIU L, et al. Efficacy and safety of enhanced recovery after surgery in the perioperative period of pancreaticoduodenectomy: A systematic review and Meta-analysis[J]. J Clin Hepatol, 2022, 38(6): 1356-1363. DOI: 10.3969/j.issn.1001-5256.2022.06.026. 朱琳, 杨小李, 刘莉, 等. 加速康复外科在胰十二指肠切除术围手术期应用有效性和安全性的系统评价与Meta分析[J]. 临床肝胆病杂志, 2022, 38(6): 1356-1363. DOI: 10.3969/j.issn.1001-5256.2022.06.026.
[38]	WANG XY, CAI JP, HUANG CS, et al. Impact of enhanced recovery after surgery protocol on pancreaticoduodenectomy: a meta-analysis of non-randomized and randomized controlled trials[J]. HPB (Oxford), 2020, 22(10): 1373-1383. DOI: 10.1016/j.hpb.2020.07.001.
[39]	FLICK KF, SOUFI M, YIP-SCHNEIDER MT, et al. Routine gastric decompression after pancreatoduodenectomy: Treating the surgeon?[J]. J Gastrointest Surg, 2021, 25(11): 2902-2907. DOI: 10.1007/s11605-021-04971-w.
[40]	BUHRMAN WC, LYMAN WB, KIRKS RC, et al. Current state of enhanced recovery after surgery in hepatopancreatobiliary surgery[J]. J Laparoendosc Adv Surg Tech A, 2018, 28(12): 1471-1475. DOI: 10.1089/lap.2018.0314.