慢性胰腺炎手术对胰腺功能的影响：胰空肠吻合术及保留十二指肠的胰头切除术

Effect of surgery for chronic pancreatitis on pancreatic function: pancreatico-jejunostomy and duodenum-preserving resection of the head of the pancreas.

作者信息

Maartense Stefan, Ledeboer Michael, Bemelman Willem A, Ringers Jan, Frolich Marjike, Masclee Ad A M

机构信息

Department of Gastroenterology and Hepatology, Leiden University Medical Center, Amsterdam, The Netherlands.

出版信息

Surgery. 2004 Feb;135(2):125-30. doi: 10.1016/j.surg.2003.09.004.

DOI:10.1016/j.surg.2003.09.004

PMID:14739846

Abstract

BACKGROUND

Resection and drainage procedures are performed for chronic pancreatitis. After resection, pancreatic function deteriorates; however, little is known about the effect of drainage procedures.

METHODS

Pancreatic function was evaluated prospectively before and after surgery in 27 patients with duodenum-preserving resection of the head of the pancreas (DPRHP), and in 12 patients with pancreatico-jejunostomy (P-JS); 18 patients with chronic pancreatitis served as controls. Results of the 2 groups were not compared because of differences in patient characteristics and indications for surgery. Endpoints were exocrine function (fecal fat excretion, urinary PABA recovery), endocrine function (oral glucose tolerance test, serum C-peptide concentrations), and pancreatic polypeptide secretion.

RESULTS

Groups were not different with respect to age and duration of symptoms. Median urinary PABA recovery was not altered significantly after surgery: DPRHP, from 40% to 31%; P-JS, from 52% to 44%; and controls, from 43% to 48%. Median fecal fat also did not change significantly: DPRHP, from 6 to 12 g/24 h; P-JS, from 9 to 5 g/24 h; and controls, from 6 to 7 g/24 h. Although the integrated blood glucose value did not change after DPRHP, the integrated serum C-peptide value decreased after DPRHP (P<.02). After P-JS, the integrated blood glucose value decreased (P<.02), but there was no change in integrated serum C-peptide secretion. Neither integrated blood glucose nor C peptide values were affected in controls. Insulin dependency increased (22% to 33%) after DPRHP. Pancreatic polypeptide secretion decreased only after DPRHP (P=.003).

CONCLUSIONS

Surgery for chronic pancreatitis does not influence exocrine pancreatic function after either a drainage (P-JS) or a resection procedure (DPRHP). Clinical endocrine function is not affected after DPRHP but improves after P-JS.

摘要

背景

慢性胰腺炎患者需进行切除和引流手术。切除术后，胰腺功能会恶化；然而，关于引流手术的影响知之甚少。

方法

对27例行保留十二指肠的胰头切除术（DPRHP）的患者、12例行胰空肠吻合术（P-JS）的患者，以及18例慢性胰腺炎患者在手术前后进行前瞻性胰腺功能评估。由于患者特征和手术指征存在差异，未对两组结果进行比较。观察指标包括外分泌功能（粪脂排泄、尿对氨基苯甲酸回收率）、内分泌功能（口服葡萄糖耐量试验、血清C肽浓度）以及胰多肽分泌。

结果

各组在年龄和症状持续时间方面无差异。术后尿对氨基苯甲酸回收率中位数无显著变化：DPRHP组从40%降至31%；P-JS组从52%降至44%；对照组从43%降至48%。粪脂中位数也无显著变化：DPRHP组从6 g/24 h增至12 g/24 h；P-JS组从9 g/24 h降至5 g/24 h；对照组从6 g/24 h增至7 g/24 h。虽然DPRHP术后血糖积分值未改变，但血清C肽积分值下降（P<0.02）。P-JS术后，血糖积分值下降（P<0.02），但血清C肽分泌积分值无变化。对照组的血糖积分值和C肽值均未受影响。DPRHP术后胰岛素依赖增加（从22%增至33%）。仅DPRHP术后胰多肽分泌减少（P = 0.003）。