Objective: To explore the causes and summarize the treatment experience for clinically relevant delayed gastric emptying(DGE) after laparoscopic pancreaticoduodenectomy(LPD). Methods: The clinical data of 1 000 patients who underwent LPD in the Department of Liver Transplantation and Hepatobiliary Surgery,Shandong Provincial Hospital Affiliated to Shandong First Medical University between March 2017 and September 2022 was retrospectively collected. There were 640 males and 360 females,with an age of (60.1±11.4)years(range: 13 to 93 years),and 590 patients were older than 60 years. Depending on the severity of DGE,patients were divided into a clinically relevant DGE group and a 0/A grade DGE group. The comparison between the two groups was performed by the χ2 test,Fisher's exact probability method,t test or the rank sum test,and the effects of various treatment strategies for clinically relevant DGE were evaluated. Results: LPD was conducted successfully in all 1 000 patients,with a surgical time of (344.8±103.6)minutes(range:160 to 450 minutes) and intraoperative blood loss (M(IQR)) of 100 (150) ml(range:50 to 1 000 ml). A total of 74 patients(7.4%) developed clinically relevant DGE. Compared to those in the 0/A grade DGE group,patients in the clinically relevant DGE group had a higher preoperative body mass index of ((24.9±3.5)kg/m2 vs. (23.9±3.3)kg/m2,t=-2.419,P=0.016),more postoperative bile leakage(51.4%(38/74) vs. 10.8%(100/926)),pancreatic fistula(59.5%(44/74) vs. 22.9%(212/926)),abdominal infection(74.3%(55/74) vs.14.6%(135/926)),and abdominal bleeding(43.2%(32/74) vs. 11.3%(105/926))(all P<0.05). Among these patients,10 cases(13.5%) received enteral nutrition treatment,22 cases(29.7%) received parenteral nutrition treatment,and 42 cases(56.8%) received a combination of enteral and parenteral nutrition treatment. The time for patients to return to a normal diet was 21(14)days (range: 8 to 85 days). Compared to those who received only enteral(23.5(27.0)days) or parenteral nutrition treatment(15.5(11.0)days),patients who received a combination of enteral and parenteral nutrition treatment(25.5(31.0)days) had a longer time to return to a normal diet (Z=20.019,P<0.01). Among the 60 patients who developed secondary DGE,48 cases(80.0%) received ultrasound-guided puncture and drainage treatment,while 12 cases(20.0%) only received anti-infection treatment. The patients in the non-puncture drainage group had a longer time to return to a normal diet than those in the puncture drainage group (26.5(12.5)days vs. 20.0(11.0)days, Z=-2.369,P=0.018). Conclusions: Patients with clinically relevant DGE after LPD had a higher proportion of postoperative complications such as pancreatic fistula,biliary fistula and abdominal infection. A combination of enteral and parenteral nutrition treatment is needed for patients with a long-term course of DGE."Smooth" drainage and ani-infectious therapy could contribute to the recovery of DGE.
目的： 探讨腹腔镜胰十二指肠切除（LPD）术后临床相关胃排空延迟（DGE）的临床特征和治疗经验。 方法： 回顾性分析2017年3月至2022年9月于山东第一医科大学附属省立医院器官移植肝胆外二科接受LPD的1 000例患者的临床资料。男性640例，女性360例；年龄（60.1±11.4）岁（范围：13~93岁），其中>60岁者590例。根据患者术后是否发生临床相关（B级和C级）DGE，将患者分为临床相关DGE组和0~A级DGE组，采用χ2检验、Fisher确切概率法、独立样本t检验或秩和检验比较两组患者临床资料特点、术后并发症发生情况，分析不同方案治疗临床相关DGE的效果。 结果： 1 000例患者均顺利完成手术，手术时间（344.8±103.6）min（范围：160~450 min），术中出血量［M（IQR）］为100（150）ml（范围：50~1 000 ml）。有74例（7.4%）发生临床相关DGE；与0~A级DGE组相比，临床相关DGE组患者术前体重指数更高［（24.9±3.5）kg/m2比（23.9±3.3）kg/m2，t=-2.419，P=0.016］，术后发生胆瘘［51.4%（38/74）比10.8%（100/926）］、胰瘘［59.5%（44/74）比22.9%（212/926）］、腹腔感染［74.3%（55/74）比14.6%（135/926）］及腹腔出血［43.2%（32/74）比11.3%（105/926）］的比例更高（P值均<0.05）。临床相关DGE组中，10例（13.5%）接受肠内营养，22例（29.7%）接受肠外营养，42例（56.8%）接受肠内+肠外营养结合治疗；患者术后恢复正常饮食时间为21（14）d（范围：8~85 d）。与单纯肠内［23.5（27.0）d］及肠外营养［15.5（11.0）d］相比，肠内+肠外联合营养支持治疗组患者术后恢复正常饮食时间［25.5（31.0）d］更长（Z=20.019，P<0.01）。60例发生继发性DGE的患者中，48例（80.0%）行超声引导下穿刺引流治疗，12例（20.0%）仅行抗感染治疗；未穿刺引流组患者术后恢复正常饮食时间长于穿刺引流组［26.5（12.5）d比20.0（11.0）d，Z=-2.369，P=0.018］。 结论： LPD术后发生临床相关DGE的患者，发生胰瘘、胆瘘及腹腔感染等并发症的比例更高；DGE病程较长者需行肠内+肠外营养支持相结合治疗模式；通畅引流、控制感染有利于DGE的恢复。.