Department of Hepatobiliary, Endocrine and Transplantation Surgery, Antwerp University Hospital, Belgium.
Department of Hepatobiliary, Endocrine and Transplantation Surgery, Antwerp University Hospital, Belgium.
Pancreatology. 2017 Nov-Dec;17(6):974-982. doi: 10.1016/j.pan.2017.09.004. Epub 2017 Sep 9.
BACKGROUND/OBJECTIVES: Studies reporting on function after pancreatic surgery are frequently based on diabetes history, fasting glycemia or random glycemia. The aim of this study was to investigate prospectively the evolution of pancreatic function in patients undergoing pancreaticoduodenectomy based on proper pre- and postoperative function tests. It was hypothesised that pancreatic function deteriorates after pancreaticoduodenectomy.
Between 2013 and 2016, 78 patients undergoing pancreaticoduodenectomy for oncologic indications had a prospective evaluation of their endocrine and exocrine pancreatic function. Endocrine function was evaluated with the 75 g oral glucose tolerance test (OGTT) and the 1 mg intravenous glucagon test. Exocrine function was evaluated with a 13C-labelled mixed-triglyceride breath test. Tests were performed pre- and postoperatively.
In 90.5% (19/21) of patients with preoperatively known diabetes, no change in endocrine function was observed. In contrast, endocrine function improved in 68.1% (15/22) of patients with newly diagnosed diabetes. 40% (14/35) of patients with a preoperative normal OGTT or prediabetes experienced deterioration in function. In multivariate analysis, improvement of newly diagnosed diabetes was correlated with preoperative bilirubin levels (p = 0.045), while progression towards diabetes was correlated with preoperative C-peptidogenic index T (p = 0.037). A total of 20.5% (16/78) of patients had pancreatic exocrine insufficiency preoperatively. Another 51.3% (40/78) of patients deteriorated on exocrine level. In total, 64.1% (50/78) of patients required pancreatic enzyme-replacement therapy postoperatively.
Although deterioration of endocrine function was expected after pancreatic resection, improvement is frequently observed in patients with newly diagnosed diabetes. Exocrine function deteriorates after pancreaticoduodenectomy.
背景/目的：报道胰腺手术后功能的研究通常基于糖尿病病史、空腹血糖或随机血糖。本研究的目的是前瞻性研究基于适当的术前和术后功能测试，行胰十二指肠切除术患者的胰腺功能演变。假设胰腺切除术后胰腺功能会恶化。
2013 年至 2016 年间，78 例因肿瘤指征而行胰十二指肠切除术的患者进行了前瞻性评估其内分泌和外分泌胰腺功能。内分泌功能通过 75g 口服糖耐量试验（OGTT）和 1mg 静脉内胰高血糖素试验进行评估。外分泌功能通过 13C 标记混合三酰甘油呼吸试验进行评估。测试在术前和术后进行。
在 90.5%（19/21）术前已知糖尿病的患者中，未观察到内分泌功能变化。相比之下，在 68.1%（15/22）新诊断为糖尿病的患者中，内分泌功能得到改善。在 40%（14/35）术前 OGTT 正常或糖尿病前期的患者中，功能恶化。在多变量分析中，新诊断糖尿病的改善与术前胆红素水平相关（p=0.045），而糖尿病的进展与术前 C 肽生成指数 T 相关（p=0.037）。78 例患者中，术前有 20.5%（16/78）存在胰腺外分泌不足，另有 51.3%（40/78）患者在胰腺外分泌水平上恶化。共有 64.1%（50/78）的患者术后需要胰酶替代治疗。
尽管胰腺切除术后内分泌功能恶化是可以预期的，但在新诊断为糖尿病的患者中经常观察到改善。胰十二指肠切除术后胰腺外分泌功能恶化。
