Ueno K, Nagakawa T, Konishi K, Konishi I, Yagi M, Ohta T, Kayahara M, Ueda N, Maeda K, Miyazaki I
Department of Surgery II, School of Medicine, Kanazawa University, Japan.
Nihon Geka Gakkai Zasshi. 1988 Sep;89(9):1367-70.
The physiology after extended radical operation in patients with pancreatobiliary carcinomas and the metabolic and nutritional management were studied. Twenty-four patients who underwent pancreatoduodenectomy with extended dissection were compared with 17 patients with semi-extended dissection and 44 patients with limited or no dissection. Extended dissection meant complete dissection of the nerve plexus around the superior mesenteric artery and para-aortic node dissection. The frequency of defecation (2.7 times/day) and the blood osmolarity in the extended dissection group were significantly higher than those in the other groups during the first week after operation. The level of serum protein was significantly lower in the extended dissection group. Insulin dosage during the first 14 days after surgery was significantly greater in the extended dissection group, yet no difference was recognized in the amount of glucose administered among the 3 groups. The conclusion was as follows; frequent diarrhea, a large amount of lymph loss and increased urine volume due to an osmotic diuresis were the main causes of volume loss. So a large volume of fluid containing a high concentration of protein should be injected immediately after extended dissection to normalize serum osmotic pressure. Because of increased insulin requirement and decreased endogenous insulin production, the administration of large amount of glucose immediately after operation should be undertaken carefully.
对胰胆管癌患者扩大根治术后的生理学以及代谢和营养管理进行了研究。将24例行扩大清扫的胰十二指肠切除术患者与17例半扩大清扫患者及44例有限或未行清扫患者进行比较。扩大清扫是指完全清扫肠系膜上动脉周围的神经丛及主动脉旁淋巴结清扫。扩大清扫组术后第一周的排便频率（2.7次/天）和血液渗透压显著高于其他组。扩大清扫组的血清蛋白水平显著较低。扩大清扫组术后前14天的胰岛素用量显著更大，但三组间给予的葡萄糖量无差异。结论如下：频繁腹泻、大量淋巴液丢失以及渗透性利尿导致的尿量增加是容量丢失的主要原因。因此，扩大清扫后应立即输注大量高浓度蛋白质液体以恢复血清渗透压正常。由于胰岛素需求增加和内源性胰岛素分泌减少，术后应谨慎立即给予大量葡萄糖。
