Pessaux Patrick, Aube Christophe, Lebigot Jérome, Tuech Jean-Jacques, Regenet Nicolas, Kapel Nathalie, Caron Christine, Arnaud Jean-Pierre
Department of Visceral Surgery, Chu Angers, Hôpital La Pitié Salpétrière, Paris, France.
J Am Coll Surg. 2002 Apr;194(4):454-62. doi: 10.1016/s1072-7515(02)01126-2.
The aim of this study was to evaluate pancreatogastrostomy (PG) permeability after duodenopancreatectomy (PD) and to determine a correlation with pancreatic endocrine and exocrine functions.
This prospective study included 19 patients who underwent PD with PG between 1992 and 1999. There were 12 men and 7 women, with a mean age of 58 years (range 35 to 76 years). The mean interval between operation and evaluation was 40.3 months (range 3 to 104 months). Indications for pancreatectomy were benign lesions (n = 13) or adenocarcinoma (n = 6). Histology of the pancreatic resection margin was normal in all patients with malignancy, and the pancreatic remnant was macroscopically normal without evidence of obstructive pancreatitis. Pancreatic exocrine and endocrine functions were respectively evaluated by fecal-1 elastase and fasting blood glucose concentrations. PG permeability was determined by secretin magnetic resonance cholangiopancreatography (Secretin-MRCP).
Anastomotic permeability was considered good in seven patients (group 1, 36.8%), moderately stenosed in six patients (group 2, 31.6%), significantly stenosed in four patients (group 3, 21.1%), and obstructed in two patients (group 4, 10.5%). Fecal-1 elastase concentration was decreased in 18 patients, with a mean concentration of 80 microg/g in group 1, 98 microg/g in group 2, 67 microg/g in group 3, and 0 microg/g in group 4. There was a statistically significant correlation between Secretin-MRCP group and fecal-1 elastase concentration. Results of fasting glucose estimation were normal for 14 of 19 patients. There was no correlation between pancreatic endocrine function and Secretin-MRCP group.
Exocrine pancreatic insufficiency was presented in 95% of the patients despite a PG permeability in 68.4%. These results may be explained in part by neutralization of pancreatic enzymatic secretions by gastric acid.
本研究旨在评估十二指肠胰切除术（PD）后胰胃吻合术（PG）的通透性，并确定其与胰腺内分泌和外分泌功能的相关性。
这项前瞻性研究纳入了1992年至1999年间接受PD加PG的19例患者。其中男性12例，女性7例，平均年龄58岁（范围35至76岁）。手术与评估之间的平均间隔时间为40.3个月（范围3至104个月）。胰腺切除术的指征为良性病变（n = 13）或腺癌（n = 6）。所有恶性肿瘤患者的胰腺切除边缘组织学均正常，胰腺残端在宏观上正常，无梗阻性胰腺炎的证据。胰腺外分泌和内分泌功能分别通过粪便弹性蛋白酶-1和空腹血糖浓度进行评估。PG通透性通过促胰液素磁共振胰胆管造影（Secretin-MRCP）来确定。
7例患者的吻合口通透性良好（第1组，36.8%），6例患者中度狭窄（第2组，31.6%），4例患者明显狭窄（第3组，21.1%），2例患者梗阻（第4组，10.5%）。18例患者的粪便弹性蛋白酶-1浓度降低，第1组平均浓度为80μg/g，第2组为98μg/g，第3组为67μg/g，第4组为0μg/g。Secretin-MRCP组与粪便弹性蛋白酶-1浓度之间存在统计学显著相关性。19例患者中有14例空腹血糖估计结果正常。胰腺内分泌功能与Secretin-MRCP组之间无相关性。
尽管68.4%的患者PG通透性良好，但95%的患者存在外分泌性胰腺功能不全。这些结果可能部分是由于胃酸对胰腺酶分泌的中和作用所致。
