Friess H, Büchler M W
Department of Visceral and Transplantation Surgery, University of Bern, Inselspital, Switzerland.
Digestion. 1996;57 Suppl 1:97-102. doi: 10.1159/000201410.
Major pancreatic resection is still accompanied by considerable morbidity (35%) and mortality (10%). Typical complications, such as pancreatic fistula and abscess, are chiefly associated with exocrine pancreatic secretion. The hormone somatostatin and its analogue octreotide are well known as potent inhibitors of exocrine pancreatic secretion. In two randomised, double-blind, placebo-controlled, multicentre trials we assessed the prophylactic effect of the perioperative inhibition of exocrine pancreatic secretion by octreotide to prevent postoperative complications. Each patient received 3 X 100 micrograms/day octreotide or placebo subcutaneously. A significant reduction in fistula, abscess, fluid collection, sepsis and postoperative pancreatitis occurred with patients undergoing pancreatic resection for cancer. Results were similar in a second study, using the same protocol but recruiting only patients with chronic pancreatitis. A new randomised, controlled multicentre trial is also described, in which 300 patients with severe acute pancreatitis are being treated with or without octreotide in double-blind fashion. The results will clarify the influence of inhibition of exocrine pancreatic secretion by octreotide on the course of acute pancreatitis, and hence its potential, through inhibition of digestive enzyme secretion, as a treatment for acute pancreatitis.
胰脏大切除术仍伴随着相当高的发病率（35%）和死亡率（10%）。典型的并发症，如胰瘘和脓肿，主要与胰腺外分泌有关。激素生长抑素及其类似物奥曲肽是众所周知的胰腺外分泌强效抑制剂。在两项随机、双盲、安慰剂对照的多中心试验中，我们评估了奥曲肽围手术期抑制胰腺外分泌对预防术后并发症的效果。每位患者皮下注射3×100微克/天的奥曲肽或安慰剂。接受胰腺癌切除术的患者出现的瘘、脓肿、积液、败血症和术后胰腺炎显著减少。第二项研究采用相同方案，但仅招募慢性胰腺炎患者，结果相似。还描述了一项新的随机对照多中心试验，其中300例重症急性胰腺炎患者正以双盲方式接受或不接受奥曲肽治疗。结果将阐明奥曲肽抑制胰腺外分泌对急性胰腺炎病程的影响，从而明确其通过抑制消化酶分泌作为急性胰腺炎治疗方法的潜力。
