Background

Delayed gastric emptying (DGE) is the main complication after pancreaticoduodenectomy (PD), but the mechanism is still unclear. The aim of this study was to elucidate the role of complete resection of the gastric antrum in decreasing incidence and severity of DGE after PD.

Methods

Sprague-Dawley rats were divided into three groups: expanded resection (ER group), complete resection (CR group), and incomplete resection (IR group) of the gastric antrum. The tension (g) of remnant stomach contraction was observed. We analyzed the histological morphology of the gastric wall by different excisional methods after distal gastrectomy. Moreover, patients underwent PD at our department between January 2012 and May 2016 were included in the study. These cases were divided into IR group and CR group of the gastric antrum, and the clinical data were retrospectively analyzed.

Results

The ex vivo remnant stomachs of CR group exhibited much greater contraction tension than others (P < 0.05). The contraction tension of the remnant stomach increased with increasing acetylcholine concentration, while remained stable at the concentration of 10 × 10⁻⁵ mol/L. Furthermore, 174 consecutive patients were included and retrospectively analyzed in the study. The incidence of DGE was significantly lower (3.5% vs. 21.3%, P < 0.01) in CR group than in IR group. In addition, hematoxylin-eosin staining analyses of the gastric wall confirmed that the number of transected circular smooth muscle bundles were higher in IR group than in CR group (8.24 ± 0.65 vs. 3.76 ± 0.70, P < 0.05).

Conclusions

The complete resection of the gastric antrum is associated with decreased incidence and severity of DGE after PD. Gastric electrophysiological and physiopathological disorders caused by damage to gastric smooth muscles might be the mechanism underlying DGE.

中文翻译：

---

完全切除胃窦可降低胰十二指肠切除术后胃排空延迟的发生率和严重程度

背景

胃排空延迟（DGE）是胰十二指肠切除术（PD）后的主要并发症，但其机制尚不清楚。本研究的目的是阐明完全切除胃窦在降低 PD 后 DGE 的发生率和严重程度方面的作用。

方法

Sprague-Dawley大鼠分为胃窦扩大切除（ER组）、完全切除（CR组）和不完全切除（IR组）三组。观察到残余胃收缩的张力（g）。我们分析了远端胃切除术后不同切除方法的胃壁组织学形态。此外，2012 年 1 月至 2016 年 5 月期间在我科接受 PD 的患者也被纳入研究。将这些病例分为胃窦部IR组和CR组，对临床资料进行回顾性分析。

结果

CR组的离体残胃表现出比其他组大得多的收缩张力（P < 0.05）。残胃的收缩张力随着乙酰胆碱浓度的增加而增加，而在10×10 ^-5  mol/L的浓度下保持稳定。此外，研究中包括并回顾性分析了 174 名连续患者。CR组DGE的发生率显着低于IR组（3.5% vs. 21.3%，P < 0.01）。此外，胃壁苏木精-伊红染色分析证实，IR组横切圆形平滑肌束的数量高于CR组（8.24±0.65 vs. 3.76±0.70，P < 0.05）。

结论

胃窦部的完全切除与 PD 后 DGE 的发生率和严重程度降低有关。由胃平滑肌损伤引起的胃电生理和病理生理障碍可能是 DGE 的潜在机制。