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

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1.Examination was made of the reversibility of pancreatic changes induced by the protease inhibitor (P.I.) in remnant pancreas after partial pancreatectomy in rats. Forty male Wistar rats were grouped as group I treated with water after laparotomy, group I treated with P.I.after laparotomy, group II treated with water after pancreatectomy and group IV treated with P.I.after pancreatectomy. In groups II and IV,camostat (200mg/kg/day) was administered daily for seven days via an orogastric tube. In groups II and IV,66% distal pancreatectomy was conducted, in which gastric and splenic segments were removed. Significant increase in pancreatic weight and tissue protein content and hypertrophy of the acinar cells of the pancreas was noted after P.I.administration. In group IV,increase in these parameters was greater and persisted for four weeks after the cessation of P.I.treatment. In group II,tyophic change was reversible and rapidly ceased within seven days after the last P.I.treatment. P. … More I.-induced trophic effect may thus be concluded greater and more prolonged in remnant that in normal pancreas.2.We investigated the effect of dividing the pyloric branch of the vagus nerve and transection of the duodenum on gastric emptying using the acetaminophen method in rats to investigate the etiology of early delayd gastric emptying after pylorus preserving pancreatoduodenectomy (PPPD). The animals were divided into the following four groups. 1, group C ; shame operation, 2, group N ; division of the pyloric branch of the vagus nerve, 3, group D ; transection of the duodenum, and 4, group N+D ; pyloric denervation and doudenal transection. We traced the serial changes in gastric emptying in the four groups at 1,2 and 4 weeks after operations and compared the results. As a result, division of the neurovascular supply to the pylorus and/or transection of the duodenum, that were brought about during PPPD,caused postoperative delayd gastric emptying, which did, however, subsequently recover.3.We examined the extent to which regional lymph nodes may be dissected while preserving the superior mesenterc nerve plexus (PLsma) in PPPD for periampullary cancer. The lymph nodes were distributed uniformly on the right and left hemicircles of the superior mesenteric artery (SMA) and along its longitudinal axis. Of a total of 142 lymph nodes, 134 (94.4%) were located outside the PLsma. Dissection of the superior mesenteric lymph nodes is theoretically to be possible while preserving the supperior mesenteric nerve plexus. Less