Analysis of Risk Factors of Functional Delayed Gastric Emptying after Pylorus-Preserving Pancreatoduodenectomy_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

PAN Chunlai , HE Guijin , GU Xi , ZHAO Xiaodan , KANG Yu , WANG Liu.

Department of Breast Surgery, Shengjing Hospital of China Medical University, Shenyang 110004, China;

Corresponding author：

Keywords：

Pylorus-preserving pancreaticoduodenectomy; Complications; Functional delayed gastric emptying; Prevention

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Objective To investigate the risk factors and preventions of functional delayed gastric emptying (FDGE) after pylorus-preserving pancreatoduodenectomy (PPPD).
Methods The clinical data of 41 patients after undergoing PPPD between 2003 and 2009 in this hospital were analyzed retrospectively.
Results In all 41 cases, postoperative complications developed in 13 patients (31.7%), in which 7 patients developed FDGE (17.1%). The complications excluding FDGE (P=0.010) and diabetes (P=0.024) had remarkable relations with the FDGE in the univariate analysis; Compared with the non-FDGE patients, the albumin was declined obviously (P=0.020) while the serum direct bilirubin increased significantly (P=0.036) in the FDGE patients, while the development of FDGE had relation only with the albumin (P=0.039) and the complication of diabete (P=0.047) by the binary logistic regression analysis.
Conclusion In the patients undergoing PPPD, preoperative control of the blood glucose, preoperative correction of hypoproteinemia and hyperbilirubinemia, and centralizing PPPD in high-volume have possibly positive significance for the prevention of FDGE.

Citation： PAN Chunlai,HE Guijin,GU Xi,ZHAO Xiaodan,KANG Yu,WANG Liu.. Analysis of Risk Factors of Functional Delayed Gastric Emptying after Pylorus-Preserving Pancreatoduodenectomy. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2010, 17(9): 959-962. doi: Copy

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, 刘凤林. 重视腹部手术后消化道功能障碍的诊治 [J]. 中国实用外科杂志, 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.	马凯，李延均. 胰十二指肠切除术中引流管的放置与术后管理(附88例报告) [J]. 中国普外基础与临床杂志， 2000; 7(6): 393394.
17.	郭志义，庞明辉. 腹部手术后功能性胃排空障碍的营养支持 [J]. 中国普外基础与临床杂志， 2005; 12(5): 506507.
18.	黎介寿．肠内营养—外科临床营养支持的首选途径 [J]．中国实用外科杂志， 2003; 23(2)： 67．.

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, 刘凤林. 重视腹部手术后消化道功能障碍的诊治 [J]. 中国实用外科杂志, 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. 马凯，李延均. 胰十二指肠切除术中引流管的放置与术后管理(附88例报告) [J]. 中国普外基础与临床杂志， 2000; 7(6): 393394.
17. 郭志义，庞明辉. 腹部手术后功能性胃排空障碍的营养支持 [J]. 中国普外基础与临床杂志， 2005; 12(5): 506507.
18. 黎介寿．肠内营养—外科临床营养支持的首选途径 [J]．中国实用外科杂志， 2003; 23(2)： 67．.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Analysis of Risk Factors of Functional Delayed Gastric Emptying after Pylorus-Preserving Pancreatoduodenectomy

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