大多数胰十二指肠切除术后的患者会出现胰腺外分泌功能不全。

Department of Surgical Oncology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India.

Department of Gastroenterology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India.

Indian J Cancer. 2021 Oct-Dec;58(4):511-517. doi: 10.4103/ijc.IJC_764_18.

BACKGROUND

Pancreatic exocrine insufficiency (PEI) is a well-defined complication of malignant diseases and pancreatic resection; however, study results of PEI are less consistent. Assessment of PEI by estimation of fecal elastase (FE)-1 in stool by enzyme-linked immunosorbent essay (ELISA) is a relatively inexpensive, noninvasive, and simple test. This study assessed exocrine function of pancreas following pancreaticoduodenectomy (PD) by estimating FE-1.

METHODS

This prospective hospital-based study involved 30 patients who had undergone PD for malignancy. All 30 patients had an uneventful postoperative period under the unit's enhanced recovery after surgery (ERAS) protocol with no Grade B, C postoperative pancreatic fistula/postpancreatectomy hemorrhage as per the International Study Group of Pancreatic Surgery (ISGPS) definitions. Stool samples were collected postoperatively 3 months after surgery from all patients irrespective of clinical symptoms. The analysis was based on a solid phase ELISA used for the quantitative determination of human elastase 1 in feces. Fecal elastase was considered normal if >200 μg/gm stool, moderately reduced if 100-200 μg/gm stool, and severely reduced if <100 μg/gm stool.

RESULTS

Among 30 patients included, fecal elastase levels were moderately reduced in 10 (33.33%) and severely reduced in 20 (66.67%) patients (P <0.0001). Mean (± standard deviation) of fecal elastase was 87.12 ± 38.76 with median of 74.6 μg/gm stool. There was no significant difference in the fecal elastase levels between men and women (P = 0.057), age (P = 0.48), pancreatic duct diameter (P = 0.609), pancreatic texture (P = 0.286), and presence or absence of clinical symptoms (P = 0.181).

CONCLUSIONS

PD was frequently associated with PEI. Unfortunately PEI is an under recognized and under treated long-term sequel of PD. Fecal elastase 1 should be performed routinely in both symptomatic and asymptomatic patients. Pancreatic enzyme replacement therapy should be considered in every patient after PD.

背景

胰腺外分泌功能不全（PEI）是恶性肿瘤和胰腺切除术后的一种明确并发症；然而，PEI 的研究结果并不一致。通过酶联免疫吸附试验（ELISA）测定粪便弹性蛋白酶（FE）-1 来评估 PEI 是一种相对便宜、非侵入性且简单的测试。本研究通过测定 FE-1 来评估胰腺十二指肠切除术（PD）后的胰腺外分泌功能。

方法

本前瞻性医院研究纳入 30 名因恶性肿瘤而行 PD 的患者。所有 30 名患者均在该单位的术后强化康复（ERAS）方案下顺利完成术后阶段，无国际胰腺外科研究组（ISGPS）定义的 B、C 级术后胰瘘/胰切除术后出血。所有患者均在术后 3 个月收集粪便样本，无论有无临床症状。分析基于固相 ELISA，用于定量测定粪便中的人弹性蛋白酶 1。粪便弹性酶被认为是正常的，如果 >200 μg/gm 粪便，如果 100-200 μg/gm 粪便，则为中度减少，如果 <100 μg/gm 粪便，则为严重减少。

结果

在纳入的 30 名患者中，10 名（33.33%）患者的粪便弹性酶水平中度减少，20 名（66.67%）患者严重减少（P<0.0001）。粪便弹性酶的平均值（±标准差）为 87.12±38.76，中位数为 74.6μg/gm 粪便。男性和女性之间的粪便弹性酶水平无显著差异（P=0.057），年龄（P=0.48），胰管直径（P=0.609），胰腺质地（P=0.286）和是否存在临床症状（P=0.181）。