Straatman Jennifer, Wiegel Jim, van der Wielen Nicole, Jansma E P, Cuesta Miguel A, van der Peet Donald L
Department of Surgery, VU University Medical Center, Amsterdam, The Netherlands.
Dig Surg. 2017;34(5):364-370. doi: 10.1159/000454958. Epub 2017 Mar 18.
Survival rates after a total gastrectomy with adequate lymphadenectomy are improving, leading to a shift in outcomes of interest from survival to postoperative outcomes and symptoms. In this systematic review, we investigate gastrointestinal symptoms that occur after a gastrectomy in relation to exocrine pancreatic insufficiency and the effect of pancreatic exocrine enzyme supplementation on these symptoms.
Online databases PubMed, Embase, and Cochrane Library were systematically searched in accordance with the PRISMA guidelines. Studies that researched gastrointestinal symptoms, exocrine pancreatic function, and enzyme supplementation were identified and assessed.
The search resulted in a total of 1,023 articles after exclusion of duplicates. After performing a thorough assessment, 4 studies were included for systematic review. Exocrine pancreatic insufficiency was investigated by 2 studies; the results showed a significant decrease of total exocrine pancreatic function of up to 76%. The other 2 studies investigated the effect of pancreatic enzyme supplementation and found minor improvement in fecal consistency and a decrease in high-degree steatorrhea. No differences in individual symptom scores were reported.
Gastrointestinal symptoms such as steatorrhea, bloating, and dumping syndrome may be related to exocrine pancreatic function, initiated by total gastrectomy. Treatment with pancreatic enzymes had a minor positive effect on patients. It should be noted that these studies were of a small sample size and low quality. New and larger RCTs are necessary to either prove or disprove the benefit of pancreatic enzyme replacement therapy in the treatment of the gastrointestinal symptoms after total gastrectomy.
全胃切除并进行充分淋巴结清扫后的生存率正在提高，这使得关注的结果从生存转向术后结果和症状。在本系统评价中，我们调查了胃切除术后出现的与外分泌性胰腺功能不全相关的胃肠道症状，以及补充胰腺外分泌酶对这些症状的影响。
按照PRISMA指南对在线数据库PubMed、Embase和Cochrane图书馆进行系统检索。确定并评估了研究胃肠道症状、外分泌胰腺功能和酶补充的研究。
排除重复项后，检索共得到1023篇文章。经过全面评估，纳入4项研究进行系统评价。2项研究对外分泌性胰腺功能不全进行了调查；结果显示外分泌胰腺总功能显著下降，降幅高达76%。另外2项研究调查了补充胰腺酶的效果，发现粪便稠度略有改善，高度脂肪泻有所减少。未报告个体症状评分的差异。
脂肪泻、腹胀和倾倒综合征等胃肠道症状可能与全胃切除引发的外分泌胰腺功能有关。胰腺酶治疗对患者有轻微的积极作用。需要注意的是，这些研究样本量小且质量低。有必要开展新的、更大规模的随机对照试验，以证实或反驳胰腺酶替代疗法在治疗全胃切除术后胃肠道症状方面的益处。
