The impact of pancreaticoduodenectomy on endocrine and exocrine pancreatic function: A prospective cohort study based on pre- and postoperative function tests
The impact of pancreaticoduodenectomy on endocrine and exocrine pancreatic function: A prospective cohort study based on pre- and postoperative function tests
复制标题
DOI：
10.1016/j.pan.2017.09.004
复制
发表时间：
2017-11-01
期刊：
影响因子：
3.6
通讯作者：
De Block, Christophe
中科院分区：
文献类型：
--
作者：
Roeyen, Geert;Jansen, Miet;De Block, Christophe
背景/目标：报告胰腺手术后功能的研究通常基于糖尿病史、空腹血糖或随机血糖。本研究的目的是基于适当的术前和术后功能测试，前瞻性研究接受胰十二指肠切除术的患者胰腺功能的演变。据推测，胰十二指肠切除术后胰腺功能会恶化。方法：2013年至2016年间，对78名因肿瘤适应症接受胰十二指肠切除术的患者的内分泌和外分泌胰腺功能进行了前瞻性评估。通过75克口服葡萄糖耐量试验（OGTT）和1毫克静脉注射胰高血糖素试验评估内分泌功能。外分泌功能通过 13C 标记的混合甘油三酯呼气试验进行评估。术前和术后均进行了测试。结果：90.5%（19/21）术前已知患有糖尿病的患者中，未观察到内分泌功能发生变化。相比之下，68.1%（15/22）的新诊断糖尿病患者的内分泌功能得到改善。 40% (14/35) 术前 OGTT 正常或糖尿病前期的患者出现功能恶化。在多变量分析中，新诊断糖尿病的改善与术前胆红素水平相关（p = 0.045），而糖尿病进展与术前 C 肽生成指数 T-30 相关（p = 0.037）。共有20.5%（16/78）的患者术前存在胰腺外分泌功能不全。另外51.3%（40/78）的患者外分泌水平恶化。总共有64.1%（50/78）的患者术后需要胰酶替代治疗。结论：虽然胰腺切除术后内分泌功能会恶化，但在新诊断的糖尿病患者中经常观察到改善。胰十二指肠切除术后外分泌功能恶化。 (C) 2017 年 IAP 和 EPC。由 Elsevier B.V. 出版。保留所有权利。
Background/Objectives: Studies reporting on function after pancreatic surgery are frequently based on diabetes history, fasting glycemia or random glycemia. The aim of this study was to investigate prospectively the evolution of pancreatic function in patients undergoing pancreaticoduodenectomy based on proper pre-and postoperative function tests. It was hypothesised that pancreatic function deteriorates after pancreaticoduodenectomy.Methods: Between 2013 and 2016, 78 patients undergoing pancreaticoduodenectomy for oncologic indications had a prospective evaluation of their endocrine and exocrine pancreatic function. Endocrine function was evaluated with the 75 g oral glucose tolerance test (OGTT) and the 1 mg intravenous glucagon test. Exocrine function was evaluated with a 13C-labelled mixed-triglyceride breath test. Tests were performed pre-and postoperatively.Results: In 90.5% (19/21) of patients with preoperatively known diabetes, no change in endocrine function was observed. In contrast, endocrine function improved in 68.1% (15/22) of patients with newly diagnosed diabetes. 40% (14/35) of patients with a preoperative normal OGTT or prediabetes experienced deterioration in function. In multivariate analysis, improvement of newly diagnosed diabetes was correlated with preoperative bilirubin levels (p = 0.045), while progression towards diabetes was correlated with preoperative C-peptidogenic index T-30 (p = 0.037). A total of 20.5% (16/78) of patients had pancreatic exocrine insufficiency preoperatively. Another 51.3% (40/78) of patients deteriorated on exocrine level. In total, 64.1% (50/78) of patients required pancreatic enzyme-replacement therapy postoperatively.Conclusions: Although deterioration of endocrine function was expected after pancreatic resection, improvement is frequently observed in patients with newly diagnosed diabetes. Exocrine function deteriorates after pancreaticoduodenectomy. (C) 2017 IAP and EPC. Published by Elsevier B.V. All rights reserved.