Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.
Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.
Diabetes Metab J. 2023 Sep;47(5):703-714. doi: 10.4093/dmj.2022.0205. Epub 2023 Jun 22.
Long term quality of life is becoming increasingly crucial as survival following partial pancreatectomy rises. The purpose of this study was to investigate the difference in glucose dysregulation after pancreaticoduodenectomy (PD) or distal pancreatectomy (DP).
In this prospective observational study from 2015 to 2018, 224 patients who underwent partial pancreatectomy were selected: 152 (67.9%) received PD and 72 (32.1%) received DP. Comprehensive assessment for glucose regulation, including a 75 g oral glucose tolerance test was conducted preoperatively, and 1, 12, and 52 weeks after surgery. Patients were further monitored up to 3 years to investigate development of new-onset diabetes mellitus (NODM) in patients without diabetes mellitus (DM) at baseline or worsening of glucose regulation (≥1% increase in glycosylated hemoglobin [HbA1c]) in those with preexisting DM.
The disposition index, an integrated measure of β-cell function, decreased 1 week after surgery in both groups, but it increased more than baseline level in the PD group while its decreased level was maintained in the DP group, resulting in a between-group difference at the 1-year examination (P<0.001). During follow-up, the DP group showed higher incidence of NODM and worsening of glucose regulation than the PD group with hazard ratio (HR) 4.29 (95% confidence interval [CI], 1.49 to 12.3) and HR 2.15 (95% CI, 1.09 to 4.24), respectively, in the multivariate analysis including dynamic glycemic excursion profile. In the DP procedure, distal DP and spleen preservation were associated with better glucose regulation. DP had a stronger association with glucose dysregulation than PD.
Proactive surveillance of glucose dysregulation is advised, particularly for patients who receive DP.
随着胰十二指肠切除术（PD）后患者生存率的提高，长期生活质量变得越来越重要。本研究旨在研究 PD 与胰体尾切除术（DP）后葡萄糖调节的差异。
本前瞻性观察研究于 2015 年至 2018 年期间纳入 224 例行部分胰腺切除术的患者：152 例行 PD（67.9%），72 例行 DP（32.1%）。术前及术后 1、12 和 52 周进行葡萄糖调节综合评估，包括 75g 口服葡萄糖耐量试验。对无糖尿病（DM）的患者进行随访，直至 3 年，以调查新诊断糖尿病（NODM）的发生情况；对有 DM 的患者进行随访，以调查血糖调节恶化（糖化血红蛋白 [HbA1c] 增加≥1%）情况。
两组患者的胰岛β细胞功能综合指标（胰岛素分泌指数）在术后 1 周时均下降，但 PD 组术后 1 年时的恢复水平高于基线，而 DP 组的恢复水平仍低于基线，术后 1 年检查时两组间存在差异（P<0.001）。在随访期间，DP 组的 NODM 发生率和血糖调节恶化发生率均高于 PD 组，多因素分析中 HR 分别为 4.29（95%CI，1.49 至 12.3）和 2.15（95%CI，1.09 至 4.24）。在 DP 手术中，远端 DP 和保留脾脏与更好的血糖调节相关。DP 与血糖调节紊乱的相关性强于 PD。
建议对 DP 患者进行积极的血糖调节监测。
