Mao Yishen, Zhao Xingfei, Zhou Lihui, Lu Bin, Jin Chen, Fu Deliang, Yao Lie, Li Ji
Department of Pancreatic Surgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China.
Pancreas Disease Institute, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China.
Gland Surg. 2021 Oct;10(10):2945-2955. doi: 10.21037/gs-21-495.
Perioperative glycemic status after pancreatic surgery has never been described. However, it's essential for optimal perioperative glucose management and understanding the pathogenesis of new-onset diabetes mellitus (NODM) after pancreatectomy. Continuous glucose monitoring (CGM) system provides us a helpful tool for closely monitoring and studying perioperative glucose change. This study tried to describe and compare perioperative glucose level and glycemic variability between different types of pancreatic surgeries via CGM device.
This study was designed as a prospective observational study. Eighteen patients were enrolled and were grouped by different types of surgery received: control group (CTRL), pancreaticoduodenectomy (PD), distal pancreatectomy (DP), and total pancreatectomy (TP). CGM devices were implanted and initiated right after the surgery. Mean glucose value (MGV), coefficient of variation (CV), mean of daily difference (MODD), continuous overall net glycemic action (CONGA), and time above range (TAR)/time below range (TBR) was compared between groups to assess glucose level and glycemic variability.
TP showed the highest MGV and CV among all groups (P<0.001), while CTRL showed the lowest (P<0.001). PD and DP had similar MGV and CV lower than TP but higher than CTRL (P<0.001). TP had the highest MODD and CONGA, CTRL had the lowest, but no significant differences were found between groups. TP had the highest TAR (24.29%) and the lowest TBR (1.28%), while the control group showed the opposite. The differences in TAR/TBR between groups were all significant (P<0.05).
TP had the highest mean glucose level and the greatest glycemic variability. PD and DP had similar results: a higher mean glucose level than control but lower than TP. For glycemic variability, PD and DP seemed to have a near-normal result resembling the control group. CGM is useful for glucose monitoring in the perioperative management of pancreatic surgery.
胰腺手术后围手术期的血糖状况此前从未被描述过。然而，这对于围手术期血糖的优化管理以及理解胰腺切除术后新发糖尿病（NODM）的发病机制至关重要。连续血糖监测（CGM）系统为我们密切监测和研究围手术期血糖变化提供了一个有用的工具。本研究试图通过CGM设备描述和比较不同类型胰腺手术围手术期的血糖水平和血糖变异性。
本研究设计为前瞻性观察性研究。纳入18例患者，并根据接受的不同手术类型进行分组：对照组（CTRL）、胰十二指肠切除术（PD）、胰体尾切除术（DP）和全胰切除术（TP）。CGM设备在手术后立即植入并启动。比较各组之间的平均血糖值（MGV）、变异系数（CV）、日均差均值（MODD）、连续总体净血糖作用（CONGA）以及高于范围时间（TAR）/低于范围时间（TBR），以评估血糖水平和血糖变异性。
TP组在所有组中MGV和CV最高（P<0.001），而CTRL组最低（P<0.001）。PD组和DP组的MGV和CV相似，低于TP组但高于CTRL组（P<0.001）。TP组的MODD和CONGA最高，CTRL组最低，但各组之间无显著差异。TP组的TAR最高（24.29%），TBR最低（1.28%），而对照组则相反。各组之间TAR/TBR的差异均具有统计学意义（P<0.05）。
TP组的平均血糖水平最高，血糖变异性最大。PD组和DP组结果相似：平均血糖水平高于对照组但低于TP组。对于血糖变异性，PD组和DP组似乎接近正常，与对照组相似。CGM在胰腺手术围手术期管理中对血糖监测很有用。
