Yamada Daisaku, Takahashi Hidenori, Asukai Kei, Hasegawa Shinichiro, Wada Hiroshi, Matsuda Chu, Yasui Masayoshi, Omori Takeshi, Miyata Hiroshi, Sakon Masato
Department of Gastroenterological Surgery Osaka International Cancer Institute Osaka Japan.
Ann Gastroenterol Surg. 2021 Feb 1;5(4):575-584. doi: 10.1002/ags3.12435. eCollection 2021 Jul.
The management of diabetes mellitus (DM) after pancreatic surgery is a long-standing issue. We aimed to investigate DM concerning pancreatic surgery, including new onset diabetes mellitus (NODM), DM resolution, and the change in insulin excretion before/after pancreatic surgery.
We retrospectively investigated three different cohorts (total 403 patients) undergoing pancreatectomy. Of those, 275 patients without preoperative DM were investigated for the risk factors of NODM. Fifty-four patients without preoperative DM of the other cohort were assessed for pre/postoperative 24-hour urinary C-peptide excretion (24-hr CPR). To evaluate the influence of pancreatic surgery on DM treatment in patients with preoperative DM, 74 patients were investigated. In all those patients, the pancreatic volume in pre/postoperative images was assessed to estimate the resected pancreatic volume.
NODM was observed in 60 patients (21%), and a lower ratio of remnant pancreatic volume (RRPV) was the only significant risk factor for NODM. Postoperative 24-hr CPR was significantly associated with two factors, RRPV and preoperative 24-hr CPR. Nine of 74 patients with preoperative DM achieved DM resolution after pancreatic surgery, and the presence of gastrointestinal anastomosis was a significant preferable factor for DM resolution.
Considering the management of DM after surgery, both predicting the postoperative pancreatic volume and the presence of gastrointestinal reconstruction are significant. We concluded that the combined assessment of the predicted remnant pancreatic volume and the preoperative 24-hr CPR value is useful to predict the postoperative pancreatic function.
胰腺手术后糖尿病（DM）的管理是一个长期存在的问题。我们旨在研究与胰腺手术相关的糖尿病，包括新发糖尿病（NODM）、糖尿病缓解情况以及胰腺手术前后胰岛素排泄的变化。
我们回顾性研究了三组接受胰腺切除术的不同队列（共403例患者）。其中，对275例术前无糖尿病的患者进行了NODM危险因素的调查。对另一队列中54例术前无糖尿病的患者进行了术前/术后24小时尿C肽排泄量（24小时CPR）评估。为评估胰腺手术对术前患有糖尿病患者糖尿病治疗的影响，对74例患者进行了调查。在所有这些患者中，评估术前/术后影像中的胰腺体积以估计切除的胰腺体积。
60例患者（21%）出现NODM，残余胰腺体积比例较低（RRPV）是NODM的唯一显著危险因素。术后24小时CPR与两个因素显著相关，即RRPV和术前24小时CPR。74例术前患有糖尿病的患者中有9例在胰腺手术后实现了糖尿病缓解，胃肠道吻合的存在是糖尿病缓解的一个显著有利因素。
考虑到术后糖尿病的管理，预测术后胰腺体积和胃肠道重建的存在都很重要。我们得出结论，联合评估预测的残余胰腺体积和术前24小时CPR值有助于预测术后胰腺功能。
