| Objective:The only radical cure for the Pancreatic head carcinoma and ampullary carcinoma is surgical excision.Pancreatic head resection of duodenum(pancreaticoduodenectomy,PD)is a major operation.Bulk data shows of pancreaticoduodenal resection(PD)Mortality rate has dropped to below 5% [1-3].At present the main operation for extensive are the traditional Whipple surgery and Pylorus-preserving Pancreaticoduodenectomy(PPPD).But for the pros and cons of these two kinds of operation still has many controversial [4].For example,PPPD retained gastric helicobacter,whether its radical is affected? Is there a difference between the two kinds of operation on the incidence of postoperative complications and recovery? Earlier studies have shown that the incidence of delay in gastric emptying(DGE)after PPPD is higher,whether PPPD is an absolute factor of delayed gastric emptying after surgery? How about the influential to long-term survival between them? This research aims to through the comparison of Whipple surgery and retain pyloric duodenal head of pancreas resection(PPPD)to discuss the pros and cons of Whipple surgery and retain pyloric duodenal head of pancreas resection(PPPD).Methods:To retrospective analyze 30 patients who had been diagnosed malignant tumors in the period of the pancreatic head or around the pot belly area line with surgical treatment(Whipple surgery 20 cases,10 cases of PPPD)from the second affiliated hospital of dalian medical university in June 2010 to June 2014.Numerical variables described using mean±standard deviation(x±s).Statistical classification variables describe the adoption rate.Measurement data line t test and analysis of variance,count data line x2 test,Fisher’s exact test or rank and inspection.Results:Intraoperative situation: PPPD group operating time 298.5±43.47 min,intraoperative blood loss 300.5 ±110.12 ml,intraoperative blood transfusion volume 1.45 ±0.44 u;Whipple surgery operation time 375.25 ±42.40 min,intraoperative blood loss 350.25 ± 135.63 ml,intraoperative blood transfusion volume 1.53± 0.55 u.By t test,the result of surgery operation time is P < 0.05,the difference was statistically significant.Incidence of postoperative complications: PPPD group of pancreatic fistula,biliary fistula,postoperative infection,postoperative bleeding,abdominal cavity effusion,and the incidence of delayed gastric emptying in turn 10%,10%,10%,0,10 %,30%;Whipple surgery group of pancreatic fistula,biliary fistula,postoperative infection,postoperative bleeding,abdominal cavity effusion,and the incidence of delayed gastric emptying in 15%,10%,20%,0,15 %,15%.For two kinds of operation complications x2 test,P > 0.05,there was no statistically significant difference.Postoperative recovery,average hospitalization days PPPD 15.8±1.03 days,the average duration of indwelling gastric tube 3.9 ±0.74 days,after 3 days,an average of 529.9 ±48.24 ml of bile and gastric juice to an average of 611.4 ± 178.77 ml;Whipple surgery postoperative hospitalization days on average 18.9 ±1.41 days,after three days,gastric juice to an average of 585.9 ±37.35 ml,bile pancreatic juice an average of 100.4 ±43.02 ml.Two kinds of operative methods postoperative hospitalization days and 3 days before the postoperative bile juice flow,after statistical analysis shows P > 0.05,there was no statistically significant difference.Two kinds of operation time of indwelling gastric tube,liquid diets,time to return to normal diet,and postoperative gastric juice flow,3 days before the statistical analysis shows P < 0.05,there are significantly statistical differences between the two kinds of surgery.Delayed gastric emptying in related factors: merging other postoperative complications were 2 cases(6.7%),and other postoperative complications of the unincorporated 4 cases(13.3%),x2 test shows P > 0.05,there was no statistically significant difference;Has a history of abdominal surgery in 2 cases(6.7%),there is no history of abdominal surgery in 4 cases(13.3%),x2 test shows P > 0.05,there was no statistically significant difference;Has a history of diabetes 6 cases(20%),there is no history of diabetes 0 cases(0%),x2 test shows P < 0.05,the difference was statistically significant.Conclusions:PPPD shorten the operation time,simplifies operation.At the same time,due to retain the pylorus and the vagus nerve plexus,it reduces the postoperative dumping syndrome.For retaining the stomach digestion and storage function,it ensures the postoperative patients nutrition status and improves the postoperative quality of life.And the incidence of the postoperative complications and Whipple and no obvious difference.Comparision to Whipple surgery,PPPD is higher on the incidence of delayed gastric emptying,but studies have shown that PPPD is not the absolute factor that lead to the occurrence of delayed gastric emptying,the occurrence of delayed gastric emptying is the result of comprehensive shaping of many factors.Therefore,in the premise of strictly grasp the operation indication,PPPD is a kind of operation can be widely applied. |
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