Sauvanet Alain
Service de chirurgie digestive Hôpital Beaujon 92118 Clichy.
Rev Prat. 2002 Sep 15;52(14):1572-5.
Indications of pancreatectomy for benign diseases and a better knowledge of natural history of chronic pancreatitis need precise evaluation of functional results of pancreatic surgery. Pancreaticoduodenectomy generally results in weight loss when indicated for cancer and weight gain when indicated for chronic pancreatitis. Even when pancreatic parenchyma is normal, pancreaticoduodenectomy usually leads to exocrine insufficiency needing enzyme therapy. The risk of diabetes related to pancreaticoduodenectomy is less than 10%; in case of chronic pancreatitis, the over-risk due to surgery is less than 10% too. Left pancreatectomy does not result in exocrine insufficiency. Conversely, left pancreatectomy can induce diabetes even when pancreatic parenchyma is normal, and especially when pancreatic resection exceeds 75%. When performed for chronic pancreatitis, left pancreatectomy strongly increases the risk of diabetes related to the disease. Total pancreatectomy results in total exocrine insufficiency and diabetes with high risk of hypoglycemia. Limited pancreatectomies (isolated head resection for chronic pancreatitis, medial pancreatectomy, enucleation), rarely indicated, do not result in pancreatic failure. Among by-pass procedures, wirsungo-jejunostomy does not improve exocrine function and could reduce (or at the least delay) the risk of diabetes occurrence related to chronic pancreatitis.
胰腺良性疾病行胰腺切除术的适应证以及对慢性胰腺炎自然病程的深入了解，需要对胰腺手术的功能结果进行精确评估。胰十二指肠切除术用于治疗癌症时通常会导致体重减轻，而用于治疗慢性胰腺炎时则会导致体重增加。即使胰腺实质正常，胰十二指肠切除术通常也会导致外分泌功能不全，需要酶替代治疗。与胰十二指肠切除术相关的糖尿病风险低于10%；对于慢性胰腺炎患者，手术导致的额外风险也低于10%。左半胰腺切除术不会导致外分泌功能不全。相反，即使胰腺实质正常，左半胰腺切除术也可能诱发糖尿病，尤其是当胰腺切除超过75%时。当用于治疗慢性胰腺炎时，左半胰腺切除术会显著增加与该疾病相关的糖尿病风险。全胰腺切除术会导致完全性外分泌功能不全和糖尿病，且低血糖风险较高。有限性胰腺切除术（如针对慢性胰腺炎的孤立性胰头切除术、中段胰腺切除术、摘除术）很少应用，不会导致胰腺功能衰竭。在旁路手术中，胰管空肠吻合术不能改善外分泌功能，但可以降低（或至少延迟）与慢性胰腺炎相关的糖尿病发生风险。
