Department of Surgery, Division of Clinical Medical Science, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan.
Pancreas. 2012 Aug;41(6):928-33. doi: 10.1097/MPA.0b013e31823d837d.
The aim of this study was to investigate the relationship between histological findings of the pancreatic stump and postoperative pancreatic exocrine function.
One hundred ten patients including 80 patients undergoing pancreatoduodenectomy (PD) and 30 patients undergoing distal pancreatectomy (DP) were enrolled into this study. Postoperative exocrine pancreatic function was evaluated by 13C-labeled mixed triglyceride breath test. The areas of acinar cells, fibrotic tissues, and fatty replacement were histologically calculated in surgical specimens of the pancreatic stump.
Histologically, acinar cell area of patients undergoing PD was significantly less than that of patients undergoing DP (P = 0.025). The values of the mean percentage dose 13C cumulative 7 hours of patients undergoing PD were significantly lower than those of patients undergoing DP (P < 0.001). The rate of pancreatic exocrine insufficiency in patients undergoing PD is significantly higher than that in patients with DP (P = 0.002). There was a significant correlation between acinar cell area of the pancreatic stump and the percentage dose 13C cumulative 7 hours (R = 0.35, P < 0.001).
Pancreatoduodenectomy induced pancreatic exocrine insufficiency more frequently than DP. Histological loss of acinar cells in the pancreatic stump was strongly correlated with postoperative pancreatic exocrine function.
本研究旨在探讨胰腺残端的组织学发现与术后胰腺外分泌功能之间的关系。
本研究纳入了 110 例患者，包括 80 例行胰十二指肠切除术（PD）和 30 例行胰体尾切除术（DP）的患者。术后胰腺外分泌功能通过 13C 标记混合三酰甘油呼吸试验进行评估。在胰腺残端的手术标本中，对腺泡细胞、纤维组织和脂肪替代的区域进行组织学计算。
组织学上，行 PD 的患者的腺泡细胞面积明显小于行 DP 的患者（P = 0.025）。行 PD 的患者的平均 13C 累积 7 小时剂量百分比值明显低于行 DP 的患者（P < 0.001）。行 PD 的患者胰腺外分泌不足的发生率明显高于行 DP 的患者（P = 0.002）。胰腺残端的腺泡细胞面积与 13C 累积 7 小时的剂量百分比之间存在显著相关性（R = 0.35，P < 0.001）。
胰十二指肠切除术比 DP 更易引起胰腺外分泌不足。胰腺残端腺泡细胞的组织学丢失与术后胰腺外分泌功能密切相关。
