Small amounts of tissue preserve pancreatic function: Long-term follow-up study of middle-segment preserving pancreatectomy.
Small amounts of tissue preserve pancreatic function: Long-term follow-up study of middle-segment preserving pancreatectomy.
复制标题
少量组织保留胰腺功能：中段保留胰腺切除术的长期随访研究。
DOI：
10.1097/md.0000000000005274
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发表时间：
2016-11
期刊：
影响因子：
1.6
通讯作者：
Miao Y
中科院分区：
文献类型：
--
作者：
Lu Z;Yin J;Wei J;Dai C;Wu J;Gao W;Xu Q;Dai H;Li Q;Guo F;Chen J;Xi C;Wu P;Zhang K;Jiang K;Miao Y
保留中段胰腺切除术(MPP)是一种在保留胰腺功能的同时治疗胰腺多灶性病变的新方法。然而，该手术后的长期胰腺功能仍不清楚。这项研究的目的是研究MPP术后的短期和长期结果，特别是长期的胰腺内分泌功能。对2011年9月至2015年12月在我院行MPP治疗的7例患者进行回顾性分析，并对5例远期疗效进行分析。用计算机断层扫描体积计计算组织保存率。测定5例患者口服葡萄糖后的血清胰岛素和C-肽水平。评价胰岛β细胞分泌功能，包括改良稳态模型评估胰岛β细胞功能(HOMA2-BETA)、C-肽曲线下面积(AUC)和C-肽指数，并与胰腺十二指肠切除术(PD)和全胰腺切除术后进行比较。采用问卷调查法对患者外分泌功能进行评估。我们的病例系列包括3名女性和2名男性，中位年龄50岁(37-81岁)。4例行保留幽门的PD联合远端胰腺切除术(DP)，其中1例保留脾。另1例患者行Beger手术和保脾DP。中位手术时间330(250~615)min，术中估计出血量800(400~5500)mL。组织学检查发现胰腺转移瘤3例，慢性胰腺炎1例，神经内分泌肿瘤1例。术后主要并发症为胃排空延迟3例，术后胰瘘2例。影像检查显示，保留了18.2%~39.5%的胰腺血供良好的节段。对胰腺功能的平均随访时间为35.0个月，在4名术前正常血糖的患者中，只有1名患者发生了新发糖尿病。这组患者的β细胞功能参数与Whiple手术后相当，似乎好于全胰腺切除术后的患者。没有发现任何患者有低血糖症状，尽管有一半的患者报告有外分泌不足的症状。综上所述，MPP是治疗胰腺中段多中心病变的一种可行而有效的手术方法，患者术后内分泌功能满意。
Middle-segment preserving pancreatectomy (MPP) is a novel procedure for treating multifocal lesions of the pancreas while preserving pancreatic function. However, long-term pancreatic function after this procedure remains unclear. The aims of this current study are to investigate short- and long-term outcomes, especially long-term pancreatic endocrine function, after MPP. From September 2011 to December 2015, 7 patients underwent MPP in our institution, and 5 cases with long-term outcomes were further analyzed in a retrospective manner. Percentage of tissue preservation was calculated using computed tomography volumetry. Serum insulin and C-peptide levels after oral glucose challenge were evaluated in 5 patients. Beta-cell secreting function including modified homeostasis model assessment of beta-cell function (HOMA2-beta), area under the curve (AUC) for C-peptide, and C-peptide index were evaluated and compared with those after pancreaticoduodenectomy (PD) and total pancreatectomy. Exocrine function was assessed based on questionnaires. Our case series included 3 women and 2 men, with median age of 50 (37–81) years. Four patients underwent pylorus-preserving PD together with distal pancreatectomy (DP), including 1 with spleen preserved. The remaining patient underwent Beger procedure and spleen-preserving DP. Median operation time and estimated intraoperative blood loss were 330 (250–615) min and 800 (400–5500) mL, respectively. Histological examination revealed 3 cases of metastatic lesion to the pancreas, 1 case of chronic pancreatitis, and 1 neuroendocrine tumor. Major postoperative complications included 3 cases of delayed gastric emptying and 2 cases of postoperative pancreatic fistula. Imaging studies showed that segments representing 18.2% to 39.5% of the pancreas with good blood supply had been preserved. With a median 35.0 months of follow-ups on pancreatic functions, only 1 patient developed new-onset diabetes mellitus of the 4 preoperatively euglycemic patients. Beta-cell function parameters in this group of patients were quite comparable to those after Whipple procedure, and seemed better than those after total pancreatectomy. No symptoms of hypoglycemia were identified in any patient, although half of the patients reported symptoms of exocrine insufficiency. In conclusion, MPP is a feasible and effective procedure for middle-segment sparing multicentric lesions in the pancreas, and patients exhibit satisfied endocrine function after surgery.