Pancreatic resection: Effects on glucose metabolism
Pancreatic resection: Effects on glucose metabolism
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DOI：
10.1007/s002680020337
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发表时间：
2001-04-01
影响因子：
2.6
通讯作者：
Andersen, DK
中科院分区：
文献类型：
--
作者：
Slezak, LA;Andersen, DK
胰腺切除导致激素异常，这取决于腺体切除部分的范围和位置（近端与远端）。胰源性糖尿病是由胰腺切除术引起的葡萄糖耐受不良。它与不同于I型（胰岛素依赖型）和II型（胰岛素非依赖型或成人型）糖尿病的特征相关。伴随持续内源性葡萄糖产生和增强的外周胰岛素敏感性的肝胰岛素抵抗导致脆性形式的糖尿病，这可能难以管理。除了胰岛素缺乏症之外，如果切除分别是远端或近端，则伴随胰腺切除的内分泌异常可能包括胰高血糖素缺乏症或胰腺多肽（PP）缺乏症。胰高血糖素缺乏可导致医源性低血糖，PP缺乏可导致由于肝脏胰岛素作用受损而导致的持续性高血糖。保留十二指肠的胰腺切除术，如胰尾切除术、保留十二指肠的胰头切除术（Beger手术），或扩大侧胰肠吻合术伴胰头挖除与标准的保留幽门的胰十二指肠切除术相比，（维普莱切除术）或全胰腺切除术：胰腺疾病的手术治疗应包括尽量减少胰腺切除术的激素损害的策略。
Pancreatic resection results in hormonal abnormalities that are dependent on the extent and location (proximal versus distal) of the resected portion of the gland. The form of glucose intolerance which results from pancreatic resection is termed pancreatogenic diabetes. It is associated with features distinct from both type I (insulin-dependent) and type II (insulin-independent, or adult-onset) diabetes. Hepatic insulin resistance with persistent endogenous glucose production and enhanced peripheral insulin sensitivity result in a brittle form of diabetes which can he difficult to manage, In addition to insulin deficiency, the endocrine abnormalities that accompany pancreatic resection can include glucagon deficiency or pancreatic polypeptide (PP) deficiency if the resection is distal of proximal, respectively. Glucagon deficiency can contribute to iatrogenic hypoglycemia, and PP deficiency can contribute to persistent hyperglycemia due to impaired hepatic insulin action. Pancreatic resections that spare the duodenum, such as distal pancreatectomy, duodenum-preserving pancreatic head resection (Beger procedure), or extended lateral pancreaticojejunostomy with excavation of the pancreatic head (Frey procedure), are associated with a lower incidence of new or worsened diabetes than the standard err pylorus-preserving pancreaticoduodenectomy (Whipple procedure) or total pancreatectomy: Operative consideration for the treatment of pancreatic disease should include strategies to minimize the hormonal impairment of pancreatic resection.