Ida Keisuke, Kobayashi Shinjiro, Tsuchihashi Atsuhito, Koizumi Satoshi, Otsubo Takehito
Department of Gastroenterological and General Surgery, St. Marianna University School of Medicine, 2-16-1 Sugao Miyamae-Ku, Kawasaki-Shi, Kanagawa-Ken, 216-8511, Japan.
Indian J Gastroenterol. 2024 Jul 16. doi: 10.1007/s12664-024-01592-4.
Some researchers are concerned that the performance of pancreatic resection in cases of low malignancy with distal localization will increase, resulting in the occurrence or worsening of post-operative glucose intolerance. Herein, we retrospectively investigated the relationship between the pancreatic resection ratio and post-operative glucose intolerance in distal pancreatectomy (DP).
Total 135 patients who underwent DP at our hospital and were followed up for > 12 months between January 2013 and December 2022 were included. Of these, 52 patients were included, excluding those with pre-operative diabetes and those who underwent pancreatectomy using other than a stapling device. The pancreatic resection ratio (%) was measured using pancreatic volumetry by manually tracing the pancreatic area on computed tomography images obtained before and after surgery and the relationship with post-operative glucose intolerance was investigated.
Among the 52 patients, 13 (25.0%) showed post-operative worsening of glucose tolerance (impaired glucose tolerance [IGT] group). The pancreatic resection ratios were 51.1% and 34.8% in the IGT (13 patients) and non-IGT groups (39 patients), respectively (p = 0.0027). The cut-off value for the IGT group was 46.5%. The resection site was divided into two groups as follows. One group was resected near the portal vein (portal group) and the other group was resected more caudally (caudal group). Mean pancreatic resection ratios were 46.5% and 28.5% in cases of resection of the portal group (30 patients) and caudal group (22 patients), respectively (p < 0.0001). The thickness of the pancreas at the resection site was 13.1 mm in the portal group and 17.7 mm in the caudal group (p < 0.0001) and the incidence of pancreatic fistula was 6.7% and 9.1%, respectively (p = 0.7472). The incidence of post-operative glucose intolerance was 40.0% (12/30) in the portal group and 4.5% (1/22) in the caudal group (p = 0.0016).
In cases of low-grade tumors and benign disease, pancreatic resection with preservation of the remaining pancreatic volume should be considered whenever possible.
一些研究人员担心，远端定位的低恶性肿瘤病例中胰腺切除术的实施将会增加，从而导致术后糖耐量异常的发生或恶化。在此，我们回顾性研究了胰腺切除术切除率与远端胰腺切除术（DP）术后糖耐量异常之间的关系。
纳入2013年1月至2022年12月期间在我院接受DP并随访超过12个月的135例患者。其中，排除术前糖尿病患者以及使用吻合器以外的方法进行胰腺切除术的患者后，纳入52例患者。通过在术前和术后获得的计算机断层扫描图像上手动描绘胰腺区域，使用胰腺容积测量法测量胰腺切除率（%），并研究其与术后糖耐量异常的关系。
在这52例患者中，13例（25.0%）出现术后糖耐量恶化（糖耐量受损[IGT]组）。IGT组（13例患者）和非IGT组（39例患者）的胰腺切除率分别为51.1%和34.8%（p = 0.0027）。IGT组的截断值为46.5%。将切除部位分为以下两组。一组在门静脉附近切除（门静脉组），另一组在更靠尾侧切除（尾侧组）。门静脉组（30例患者）和尾侧组（22例患者）切除病例的平均胰腺切除率分别为46.5%和28.5%（p < 0.0001）。门静脉组切除部位的胰腺厚度为13.1 mm，尾侧组为17.7 mm（p < 0.0001），胰瘘发生率分别为6.7%和9.1%（p = 0.7472）。门静脉组术后糖耐量异常发生率为40.0%（12/30），尾侧组为4.5%（1/22）（p = 0.0016）。
对于低级别肿瘤和良性疾病病例，应尽可能考虑保留剩余胰腺体积的胰腺切除术。
