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

1.实验研究1)探讨大胰腺切除术后保留全胃对胰腺内分泌功能的影响。实验动物被分为单纯大胰腺切除组和胰腺切除加胃切除组。2)观察口服胰酶抑制剂对上述胰腺功能障碍的影响。应用胰酶抑制剂后，残余胰腺组织重量明显增加，糖耐量受损有改善趋势。3)整块切除胃和十二指肠的大鼠胰腺重量、胰腺DNA、RNA和蛋白质含量均下降。五肽胃泌素改善这种胰腺萎缩的程度与对照组…相似2)临床研究1)采用Billroth-I型重建术联合远端胃部分切除术(标准PD)和保留幽门、十二指肠球部切除(PPPD)的胰腺十二指肠切除术后，测定血浆胃泌素和CCK的反应。PPPD后基础和餐后胃泌素水平在模式上与对照组相似。标准腹膜透析患者基础血浆CCK水平明显低于对照组，餐后CCK水平明显高于标准腹膜透析患者。提示胰腺切除时保留胃和十二指肠球部对十二指肠球部有更多的有益影响，CCK对胰腺有营养作用。较少

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