Yamaguchi T, Miyata M, Kamiike W, Kobayashi Y, Matsuda H
First Department of Surgery, Osaka University Medical School, Japan.
Surg Today. 1997;27(5):420-8. doi: 10.1007/BF02385705.
To clarify the histological status of the pancreas tail after pancreatoduodenectomy (PD), fibrosis, islets of Langerhans, and A, B, and D cells were examined histometrically in surgical cases of pancreatic cancer. The same investigations were also performed during an autopsy examination of the pancreas tail of survivors of surgery who had received either PD or total pancreatectomy with segmental autotransplantation (SAT). In the surgical cases, fibrosis and the islet percentage compared with nonpancreatic cancer cases were significantly higher while the B cell ratio was significantly lower. In addition, in pancreatic cancer patients, the fibrosis and islet ratio in the group with a blocked pancreatic duct were higher while the B cell ratio was lower than in the group with an open pancreatic duct. A direct relationship between the islet ratio and the degree of fibrosis, and an inverse relationship between the B cell ratio and the degree of fibrosis, were thus found. From the autopsy cases, the fibrosis progressed and the islet ratio increased following PD, but after SAT only the islet ratio increased compared to the time of surgery. The progression of fibrosis after PD thus suggests the presence of some problems in both the surgical method and postoperative management.
为明确胰十二指肠切除术（PD）后胰尾的组织学状态，对胰腺癌手术病例的纤维化、胰岛以及A、B和D细胞进行了组织计量学检查。在接受PD或全胰切除术加节段性自体移植（SAT）的手术幸存者的胰腺尾部尸检中也进行了同样的研究。在手术病例中，与非胰腺癌病例相比，纤维化和胰岛百分比显著更高，而B细胞比例显著更低。此外，在胰腺癌患者中，胰管阻塞组的纤维化和胰岛比例高于胰管通畅组，而B细胞比例低于胰管通畅组。因此，发现胰岛比例与纤维化程度之间存在直接关系，B细胞比例与纤维化程度之间存在反比关系。从尸检病例来看，PD后纤维化进展且胰岛比例增加，但SAT后仅胰岛比例相对于手术时增加。PD后纤维化的进展提示手术方法和术后管理均存在一些问题。
