Sikkens Edmée C M, Cahen Djuna L, de Wit Jill, Looman Caspar W N, van Eijck Casper, Bruno Marco J
Departments of *Gastroenterology and Hepatology ‡Surgery †Public Health, Erasmus University Medical Center, Rotterdam, the Netherlands.
J Clin Gastroenterol. 2014 May-Jun;48(5):e43-6. doi: 10.1097/MCG.0b013e31829f56e7.
In cancer of the pancreatic head region, exocrine insufficiency is a well-known complication, leading to steatorrhea, weight loss, and malnutrition. Its presence is frequently overlooked, however, because the primary attention is focused on cancer treatment. To date, the risk of developing exocrine insufficiency is unspecified. Therefore, we assessed this function in patients with tumors of the pancreatic head, distal common bile duct, or ampulla of Vater.
Between March 2010 and August 2012, we prospectively included patients diagnosed with cancer of the pancreatic head region at our tertiary center. To preclude the effect of a resection, we excluded operated patients. Each month, the exocrine function was determined with a fecal elastase test. Furthermore, endocrine function, steatorrhea-related symptoms, and body weight were evaluated. Patients were followed for 6 months, or until death.
Thirty-two patients were included. The tumor was located in the pancreas in 75%, in the bile duct in 16%, and in the ampullary region in 9%, with a median size of 2.5 cm. At diagnosis, the prevalence of exocrine insufficiency was 66%, which increased to 92% after a median follow-up of 2 months (interquartile range, 1 to 4 mo).
Most patients with cancer of the pancreatic head region were already exocrine insufficient at diagnosis, and within several months, this function was impaired in almost all cases. Given this high prevalence, physicians should be focused on diagnosing and treating exocrine insufficiency, to optimize the nutritional status and physical condition, especially for those patients undergoing palliative chemotherapy and/or radiotherapy.
在胰头区域癌中，外分泌功能不全是一种众所周知的并发症，可导致脂肪泻、体重减轻和营养不良。然而，其存在常常被忽视，因为主要注意力集中在癌症治疗上。迄今为止，发生外分泌功能不全的风险尚不明确。因此，我们评估了胰头、胆总管远端或十二指肠乳头肿瘤患者的这一功能。
2010年3月至2012年8月期间，我们前瞻性纳入了在我们三级中心被诊断为胰头区域癌的患者。为排除手术的影响，我们排除了已接受手术的患者。每月通过粪便弹性蛋白酶检测确定外分泌功能。此外，还评估了内分泌功能、与脂肪泻相关的症状和体重。对患者进行6个月的随访，或直至死亡。
纳入32例患者。肿瘤位于胰腺的占75%，位于胆管的占16%，位于壶腹区域的占9%，中位大小为2.5 cm。诊断时，外分泌功能不全的患病率为66%，在中位随访2个月（四分位间距，1至4个月）后增至92%。
大多数胰头区域癌患者在诊断时就已经存在外分泌功能不全，并且在几个月内，几乎所有病例的这一功能都受到损害。鉴于这种高患病率，医生应关注外分泌功能不全的诊断和治疗，以优化营养状况和身体状况，特别是对于那些接受姑息化疗和/或放疗的患者。
