对于营养不良的患者，近端胰腺次全切除术可作为全胰腺切除术的替代方案。
Proximal subtotal pancreatectomy as an alternative to total pancreatectomy for malnourished patients.
作者信息
Nakagawa Yuki, Kato Hiroyuki, Maeda Koki, Noguchi Daisuke, Gyoten Kazuyuki, Hayasaki Aoi, Iizawa Yusuke, Fujii Takehiro, Tanemura Akihiro, Murata Yasuhiro, Kuriyama Naohisa, Kishiwada Masashi, Sakurai Hiroyuki, Isaji Shuji, Mizuno Shugo
机构信息
Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University Graduate School of Medicine, Tsu, Mie, 514-8507, Japan.
Mie University Graduate School of Medicine, Tsu, Mie, Japan.
出版信息
Surg Today. 2021 Oct;51(10):1619-1629. doi: 10.1007/s00595-021-02269-7. Epub 2021 Apr 7.
PURPOSE
To investigate whether proximal subtotal pancreatectomy (PSTP) is superior to total pancreatectomy (TP) for preserving postoperative endocrine function, and to identify the pre-operative risk factors influencing prognosis after TP and PSTP.
METHODS
The subjects of this retrospective study were patients who underwent TP (n = 15) or PSTP (n = 16) between 2008 and 2018 in our hospital. First, we compared the incidence of hypoglycemia within 30 days after surgery and the total daily amount of insulin needed in the 30 days after TP vs. PSTP. Then, we compared the prognoses between the groups.
RESULTS
The incidence of hypoglycemia in the 30 days after surgery was significantly lower in the PSTP group than in the TP group (n = 0 vs. n = 5; p < 0.001). The total amount of daily insulin given was also significantly lower after PSTP than after TP: (0 units vs. 18 units, p = 0.001). Lower lymphocyte counts (p = 0.014), lower cholinesterase (p = 0.021), and lower prognostic nutrition index (p = 0.021) were identified as significant risk factors for hypoglycemia in the TP group. Low cholinesterase (p = 0.015) and a low prognostic nutrition index (p = 0.048) were significantly associated with an unfavorable prognosis in the TP group, but not in the PSTP group.
CONCLUSIONS
PSTP may be a feasible alternative to TP to preserve endocrine function, especially for malnourished patients.
目的
探讨近端胰腺次全切除术（PSTP）在保留术后内分泌功能方面是否优于全胰切除术（TP），并确定影响TP和PSTP术后预后的术前危险因素。
方法
本回顾性研究的对象为2008年至2018年在我院接受TP（n = 15）或PSTP（n = 16）的患者。首先，我们比较了TP组和PSTP组术后30天内低血糖的发生率以及术后30天所需胰岛素的每日总量。然后，我们比较了两组之间的预后情况。
结果
PSTP组术后30天内低血糖的发生率显著低于TP组（n = 0 vs. n = 5；p < 0.001）。PSTP术后每日胰岛素总量也显著低于TP术后：（0单位 vs. 18单位，p = 0.001）。淋巴细胞计数较低（p = 0.014）、胆碱酯酶较低（p = 0.021）和预后营养指数较低（p = 0.021）被确定为TP组低血糖的显著危险因素。胆碱酯酶低（p = 0.015）和预后营养指数低（p = 0.048）与TP组的不良预后显著相关，但与PSTP组无关。
结论
PSTP可能是TP保留内分泌功能的一种可行替代方案，尤其是对于营养不良的患者。
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