Eriksson J, Doepel M, Widén E, Halme L, Ekstrand A, Groop L, Höckerstedt K
Helsinki University Central Hospital, IV Department of Medicine, Finland.
Gut. 1992 Jun;33(6):843-7. doi: 10.1136/gut.33.6.843.
Acute fulminant pancreatitis is associated with significant morbidity and mortality. To examine the outcome of conservative and surgical treatment of this disorder, 36 patients who survived an initial episode were restudied after a mean of six years. Fifty three per cent had developed diabetes mellitus, half of whom required insulin therapy. Pancreatic resection was associated with a 100% frequency of diabetes, while only 26% of those treated with peritoneal lavage developed this (p less than 0.001). Insulin secretion and sensitivity were assessed using the hyperglycaemic glucose clamp technique. First phase insulin secretion was impaired in surgically treated patients (mean (SEM) 14 (5) microU/ml x 10 minutes) compared with conservatively treated patients and control subjects (144 (66) and 87 (12) microU/ml x 10 minutes, respectively; p less than 0.05). Second phase and 'maximal' insulin secretion were also impaired among the surgically treated patients compared with the conservatively treated patients and the controls. Insulin sensitivity was reduced among the surgically treated patients (2.88 (58) mg/kg.minute) when compared with conservatively treated patients and healthy control subjects (5.87 (1.02) and 6.45 (0.66) mg/kg.minute; p less than 0.05). Pancreatic resection is associated with a very high frequency of diabetes compared with peritoneal lavage, and these results favour conservative treatment of active fulminant pancreatitis whenever possible.
急性暴发性胰腺炎与显著的发病率和死亡率相关。为了研究这种疾病保守治疗和手术治疗的结果，对36名度过首次发作的患者进行了平均六年的再次研究。53%的患者患了糖尿病，其中一半需要胰岛素治疗。胰腺切除术后糖尿病发生率为100%，而接受腹腔灌洗治疗的患者中只有26%患糖尿病（p<0.001）。使用高血糖葡萄糖钳夹技术评估胰岛素分泌和敏感性。与保守治疗患者和对照组相比，手术治疗患者的第一阶段胰岛素分泌受损（平均（标准误）为14（5）微单位/毫升×10分钟），保守治疗患者和对照组分别为144（66）和87（12）微单位/毫升×10分钟（p<0.05）。与保守治疗患者和对照组相比，手术治疗患者的第二阶段和“最大”胰岛素分泌也受损。与保守治疗患者和健康对照组相比，手术治疗患者的胰岛素敏感性降低（2.88（58）毫克/千克·分钟），保守治疗患者和健康对照组分别为5.87（1.02）和6.45（0.66）毫克/千克·分钟（p<0.05）。与腹腔灌洗相比，胰腺切除术后糖尿病发生率非常高，这些结果支持在可能的情况下对急性暴发性胰腺炎进行保守治疗。
