Maeda Hiromichi, Okabayashi Takehiro, Yatabe Tomoaki, Yamashita Koichi, Hanazaki Kazuhiro
Department of Surgery, Kochi Medical School, Kochi University, Kohasu-Okocho, Nankoku-City, Kochi 783-8505, Japan.
World J Gastroenterol. 2009 Sep 7;15(33):4111-5. doi: 10.3748/wjg.15.4111.
Perioperative glycemic control is important for reducing postoperative infectious complications. However, clinical trials have shown that efforts to maintain normoglycemia in intensive care unit patients result in deviation of glucose levels from the optimal range, and frequent attacks of hypoglycemia. Tight glycemic control is even more challenging in those undergoing pancreatic resection. Removal of lesions and surrounding normal pancreatic tissue often cause hormone deficiencies that lead to the destruction of glucose homeostasis, which is termed pancreatogenic diabetes. Pancreatogenic diabetes is characterized by the occurrence of hyperglycemia and iatrogenic severe hypoglycemia, which adversely effects patient recovery. Postoperatively, a variety of factors including surgical stress, inflammatory cytokines, sympathomimetic drug therapy, and aggressive nutritional support can also affect glycemic control. This review discusses the endocrine aspects of pancreatic resection and highlights postoperative glycemic control using a closed-loop system or artificial pancreas. In previous experiments, we have demonstrated the reliability of the artificial pancreas in dogs with total pancreatectomy, and its postoperative clinical use has been shown to be effective and safe, without the occurrence of hypoglycemic episodes, even in patients after total pancreatectomy. Considering the increasing requirement for tight perioperative glycemic control and the recognized risk of hypoglycemia, we propose the use of an artificial endocrine pancreas that is able to monitor continuously blood glucose concentrations with proven accuracy, and administer automatically substances to return blood glucose concentration to the optimal narrow range.
围手术期血糖控制对于减少术后感染并发症至关重要。然而，临床试验表明，在重症监护病房患者中维持正常血糖水平的努力会导致血糖水平偏离最佳范围，并频繁发生低血糖。在接受胰腺切除术的患者中，严格的血糖控制更具挑战性。病变及周围正常胰腺组织的切除常导致激素缺乏，进而破坏葡萄糖稳态，这被称为胰源性糖尿病。胰源性糖尿病的特征是发生高血糖和医源性严重低血糖，这对患者的恢复产生不利影响。术后，包括手术应激、炎性细胞因子、拟交感神经药物治疗和积极的营养支持等多种因素也会影响血糖控制。本综述讨论了胰腺切除的内分泌方面，并强调了使用闭环系统或人工胰腺进行术后血糖控制。在先前的实验中，我们已经证明了人工胰腺在全胰切除犬中的可靠性，并且其术后临床应用已被证明是有效且安全的，即使在全胰切除术后的患者中也未发生低血糖事件。考虑到围手术期严格血糖控制的需求不断增加以及公认的低血糖风险，我们建议使用一种人工内分泌胰腺，它能够以经证实的准确性连续监测血糖浓度，并自动给予物质以使血糖浓度恢复到最佳窄范围。
