Promotion of regeneration of remnant pancreas after pancreatectomy and modification of pylorus-preserving procedure

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1.Experimental studies 1).The effect of preserving the total stomach on endocrine pancreatic function after major pancreatectomy was imvestigated. The animals were divided into those with major pancreatectomy alone and those with pancreatectomy plus gastrectomy. In the latter, glucose tolerance and insulin release were more impa ; ired, suggesting that preservation of the total stomach is effective for saving the impaired pancreatic function after pancreatectomy.2).The effect of oral administration of trypsin inhibitor on the above-mentioned pancreatic dysfunction was observed. By means of trypsin inhibitor, a significant increase in the tissue weight was demonstrated in the remnant pancreas and the impaired glucose tolerance tended to be improved.3).The animals, in which the stomach and the duodenum were removed en bloc, showed decrease in pancreatic weight pancreatic DNA, RNA and protein contents. Pentagastrin ameliorated such pancreatic atrophy to similar degree to the control group … More , indicatying that endogenous gastrin is an important regulator of the pancreas.2.Clinical studies 1).Plasma gastrin and CCK responses were measured after a pancreatoduodenectomy using Billroth-I type reconstruction combined with distal partial gastrectomy(standard PD) and combined with presevation of the pylorus and the duodenal bulb.(PPPD). Basal and postprandial levels of gastrin after PPPD was similar in pattern to that found in controls. Basal plasma levels of CCK in the patients after standard PD were significantly lower than in controls, and significant higher postprandial levels of CCK were found after PPPD compared to standard PD.These results suggest that presevation of the stomach and the duodenal bulb in pancreatectomy has more beneficial effect on the duodenal bulb in pancreatectomy has more and CCK are known to have a trophic effect on the pancreas.2).The follow-up study showed that nutritional conditions in the patients treated by PPPD were better than those by standard PD. Less