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

1.实验研究1)。探讨大胰切除术后保留全胃对胰腺内分泌功能的影响。动物分为单独行大胰切除术和胰切除术加胃切除术两组。后者的糖耐量和胰岛素释放量更大；提示保留全胃对挽救胰腺切除术后受损的胰腺功能是有效的2)。观察口服胰蛋白酶抑制剂对上述胰腺功能障碍的影响。胰蛋白酶抑制剂可使残胰腺组织重量显著增加，糖耐量受损有改善的趋势。整体切除胃和十二指肠的大鼠胰腺重量下降，胰腺DNA、RNA和蛋白质含量下降。Pentagastrin对这种胰腺萎缩的改善程度与对照组相似…More，表明内源性胃泌素是胰腺的重要调节因子。临床研究1)。采用Billroth-I型重建联合远端部分胃切除术（标准PD）和保留幽门和十二指肠球（PPPD）进行胰十二指肠切除术后，测量血浆胃泌素和CCK反应。PPPD后胃泌素的基础和餐后水平与对照组相似。标准PD后患者的基础血浆CCK水平明显低于对照组，PPPD后的餐后CCK水平明显高于标准PD。这些结果提示，胰腺切除术中保留胃和十二指肠球对十二指肠球有更大的有益作用，CCK对胰腺有营养作用(2)。随访研究表明，PPPD治疗组的营养状况优于标准PD治疗组。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