The Literature Review Of Delayed Gastric Emptying After Pancreaticoduodenectomy And The Report Of 3 Cases

OBJECTTo investigate the risk factors associated with the occurance of delayed gastric emptying(DGE)after pancreaticoduodenectomy(PD)and explore the causes,diagnosis and treatment of DGE.METHODSRetrospectively analyze 43 patients’ Postoperative recovery of pancreaticoduodenectomy performed between January 2015 and January 2018 in the Department of Hepatobiliary and Pancreatic Surgery of the Second Hospital of Tianjin Medical University.The surgical method is Whipple+Braun anastomosis.Comprehensive analyze by summarizing the data of the above DGE patients and referring to DGE-related literatures after PD at home and abroad.RESULTSAccording to the classification of delayed gastric emptying by the International Pancreatic Surgery Group(ISGPS),the above three diagnosed DGE patients in our hospital were graded: 2 patients with grade B,and 1 patient with grade C.One patient with grade B and one patient with grade C had jejunal feeding tubes inserted intraoperatively.After diet resistance,gastrointestinal decompression,nutritional support,psychological intervention and other symptomatic treatment,the above 3patients’ recovery time of gastric motility was about 14-25 days after operation,with an average duration of about 18 days.All patients could take ordinary food and were cured without reoperation,severe intestinal fistula or other severe intra-abdominal complications.The patients were discharged from hospital and regularly reviewed in out-patient clinic.No delayed gastric emptying occurred again.CONCLUSIONS1.Prevention of DGE after PD We have to make full pre-operation education.It’s needed to pay attention to the psychological state of patients and their families at any time.Provide psychological intervention if necessary.2.Remedy anemia and hypoalbuminemia preoperative as much as possible to actively improve the nutritional status;if acute cholangitis or obstructive jaundicehappens,PTCD or ENCD is available.3.Intraoperative prevention of DGE Intraoperative operations should be gentle.Follow minimally invasive principles and minimize blood loss under the premise of safety.In order to avoid postoperative DGE,the classic procedure Whipple+Braun is preferred.The jejunum is in the anterior position of the colon.For high-risk patients with older age,severe conditions,strong psychological fluctuation,poor nutritional status,long operative time and big surgical trauma,the gastrojejunal fistula can be placed in the intestine during surgery,which is an effective measure to prevent delayed gastric emptying.4.Treatment of DGE after PD Actively control blood glucose level after surgery,handle of hydroelectrolytic equilibration,earlier enteral nutrition,actively correct hypoalbuminemia and anemia and control infection.The use of traditional Chinese medicine and acupuncture and moxibustion adjuvant therapy can play a role.For patients with jejunal feeding tubes inserted intraoperatively,take enteral nutrition as the main energy supplement as soon as possible on the premise of safety.5.DGE is a syndrome caused by multiple factors after PD.It is a functional lesion and will significantly increase the length of hospital stay.It can generally be cured with comprehensive treatment.Therefore,nutritional support and symptomatic treatment are the preferred means of treating DGE after PD.6.For patients with refractory DGE after PD,surgical indications and surgical timing must be strictly controlled.7.Because the mechanism and risk factors of DGE are not clear,the research on protein Ano1,Ghrelin receptor agonist and gastric electrical stimulation will become a new direction.