Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, South Korea.
Department of Surgery, Ajou University School of Medicine, Suwon, South Korea.
J Hepatobiliary Pancreat Sci. 2022 Feb;29(2):239-249. doi: 10.1002/jhbp.949. Epub 2021 Apr 15.
Factors aggravating remnant pancreas atrophy following pancreatoduodenectomy and the effects of atrophy have not been extensively studied. This study aimed to evaluate the clinical factors affecting remnant pancreas atrophy and assess the effects of atrophy on quality of life, nutritional status, and pancreatic exocrine and endocrine functions.
Data collected prospectively from 122 patients who completed 12 months of follow-up, including computed tomography and the quality-of-life questionnaire, were analyzed. Pancreas volume was measured using a computed tomography volumetry program. Endocrine and exocrine functions were evaluated.
Malignancy and adjuvant chemoradiotherapy were associated with severity of atrophy. At 12 postoperative months, quality-of-life scores and nutritional indexes were mostly not associated with atrophy, but stool elastase level decreased significantly and incidence of new-onset diabetes mellitus was higher in the severe atrophy group. Postprandial 2-hour blood glucose and glycosylated hemoglobin levels were also higher in this group.
Remnant pancreas atrophy was more severe in patients with malignant disease who received adjuvant chemoradiotherapy and was associated with pancreatic exocrine and endocrine functions. More careful monitoring and active management of exocrine and endocrine deficiencies are necessary for patients who underwent pancreatoduodenectomy for malignant disease and received chemoradiotherapy.
胰十二指肠切除术后残胰腺萎缩的加重因素及其影响尚未得到广泛研究。本研究旨在评估影响残胰腺萎缩的临床因素，并评估萎缩对生活质量、营养状况以及胰腺外分泌和内分泌功能的影响。
前瞻性收集了 122 例完成 12 个月随访的患者的数据，包括计算机断层扫描和生活质量问卷。使用计算机断层扫描容积程序测量胰腺体积。评估内分泌和外分泌功能。
恶性肿瘤和辅助放化疗与萎缩的严重程度相关。术后 12 个月，生活质量评分和营养指标与萎缩大多无关，但严重萎缩组的粪便弹性蛋白酶水平显著降低，新发糖尿病的发生率更高。该组的餐后 2 小时血糖和糖化血红蛋白水平也更高。
接受辅助放化疗的恶性肿瘤患者残胰腺萎缩更严重，与胰腺外分泌和内分泌功能有关。对于因恶性肿瘤接受胰十二指肠切除术并接受放化疗的患者，需要更仔细地监测和积极管理外分泌和内分泌不足。
