Jo Sungho, Choi Seong-Ho, Heo Jin-Seok, Kim Eun-Mi, Min Myung-Sook, Choi Dong-Wook, Seo Jeong-Meen, Chung Jun-Chul, Kim Yong-Il
Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, Seoul 135-170, South Korea.
World J Surg. 2006 Nov;30(11):1974-82; discussion 1983-4. doi: 10.1007/s00268-005-0678-5.
The effect of glutamine (Gln) supplementation in patients undergoing a major operation has not been conclusively established. This study was designed to elucidate the effect of Gln supplementation on the surgical outcome after a pancreaticoduodenectomy (PD) for periampullary tumors.
A prospective, randomized, double-blind, and controlled clinical trial was undertaken for patients who underwent a classical PD or a pylorus-preserving PD for periampullary tumors. The Gln and control groups received isonitrogenous amino acid, with a 0.2 g/kg per day Gln regimen administered to the Gln group. The surgical outcome was compared in light of length of postoperative hospital stay, nutritional and chemical profiles, and complication rate between the Gln and control groups.
Sixty of the consecutive 143 patients who were admitted to undergo operation for periampullary tumors were enrolled in our study; 32 were in the Gln group and 28 in the control group. The two groups were comparable prior to and during the operation. The median length of the postoperative hospital stay and the postoperative nutritional and chemical profiles were not different between two groups. The overall and PD-related complication rates of the Gln group (37.5% and 25.0%) and the control group (28.6% and 14.3%) were not statistically different.
No significant beneficial effect of Gln supplementation with a low-dose parenteral regimen was demonstrated on the surgical outcome after a PD for periampullary tumors. Therefore, we should be prudent in using Gln as a routine pharmacologic supplement to the standard nutrition in patients who undergo major operations.
对于接受大手术的患者补充谷氨酰胺（Gln）的效果尚未得到确切证实。本研究旨在阐明补充Gln对壶腹周围肿瘤行胰十二指肠切除术（PD）后手术结局的影响。
对因壶腹周围肿瘤接受经典PD或保留幽门的PD的患者进行一项前瞻性、随机、双盲和对照临床试验。Gln组和对照组接受等氮氨基酸，Gln组给予每天0.2 g/kg的Gln方案。根据术后住院时间、营养和生化指标以及Gln组和对照组之间的并发症发生率比较手术结局。
连续143例因壶腹周围肿瘤入院接受手术的患者中有60例纳入本研究；Gln组32例，对照组28例。两组在手术前和手术期间具有可比性。两组术后住院时间中位数以及术后营养和生化指标无差异。Gln组（37.5%和25.0%）和对照组（28.6%和14.3%）的总体并发症发生率和与PD相关的并发症发生率无统计学差异。
对于壶腹周围肿瘤行PD术后的手术结局，低剂量肠外补充Gln未显示出显著有益效果。因此，对于接受大手术的患者，在将Gln作为标准营养的常规药理补充剂使用时应谨慎。
