Abstract
Chronic pancreatitis (CP) leads to deterioration of the endocrine pancreatic function by fibrotic destruction. The aim of the present study was to investigate whether resection or duct drainage in patients with CP would have a direct impact on the pancreatic beta cell function. An intravenous glucose tolerance test (IVGTT) was performed before, after and in some cases 3 months after operation in ten patients each of whom had been treated by either resection or duct drainage. Three patients undergoing pancreatic resection for cancer served as controls. Beta cell function was assessed by glucose elimination (K-values), insulin and C-peptide response. K-Values in patients with CP were not significantly influenced after resection (1.93 ± 0.78/2.13 ± 0.72; n.s.) or drainage (1.26 ± 0.47/1.54 ± 0.58; n.s.) but reduced in all three tumor patients (2.23 ± 0.55/1.23 ± 0.43). The initial insulin response [μU/ml] in CP patients was also not altered after resection (19.7 ± 17.3/16.0 ± 18.2; n.s.) or after drainage (16.7 ± 16.5/13.0 ± 9.0; n.s.), whereas all three resected tumor patients showed reduced values (42.9 ± 15.7/17.5 ± 3.8). Stimulated C-peptide synthesis [ngmin/ml] was not substantially lowered in patients resected for CP (90.5 ± 85.6/73.8 ± 48.9; n.s.) or in the drainage group (121.3 ± 67.5/98.0 ± 57.2; n.s.), but this parameter was decreased in every tumor patient postoperatively (157.8 ± 66.9/125.1 ± 69.6). Resection in patients with chronic pancreatitis did not inevitably result in loss of beta cell function. Parenchyma-preserving drainage procedures had no measurable advantage in this respect. Therefore, the technique must be individually chosen in surgical therapy of chronic pancreatitis, depending on intention of treatment, appropriate organ morphology, and the long-term success rate of the procedure.
Zusammenfassung
Die chronische Pankreatitis (CP) führt durch Organdestruktion auch zu einer verminderten endokrinen Pankreasfunktion. Gegenstand der vorliegenden Untersuchung war die Frage, inwieweit die operative Therapie einer CP durch Parenchymresektion oder lediglich Pankreasgangdrainage einen direkten Einfluβ auf die \-Zellfunktion hat. Bei jeweils n = 10 Patienten mit Resektion oder Drainageeingriff wurde prä-, post- sowie teilweise 3 Monate postoperativ ein intravenöser Glukosetoleranztest (IVGTT) durchgeführt. Drei resezierte Tumorpatienten dienten als orientierender Vergleich. Bestimmt wurden Glukoseverwertungsgeschwindigkeit, Insulinantwort and C-Peptidsynthese. Die Glukoseverwertungsgeschwindigkeit (K-Wert) war bei Patienten mit CP weder nach Resektion (1,93 ± 0,78/2,13 ± 0,72; p = n.s.) noch nach Drainage (1,26 ± 0,47/1,54 ± 0,58; p = n.s.) signifikant unterschiedlich, im Gegensatz zur Verschlechterung bei allen 3 resezierten Tumorpatienten (2,23 ± 0,55/1,23 ± 0,43). Auch die initiale Insulinantwort [9U/ml] war weder durch Resektion (19,7 ± 17,3/16,0 ± 18,2; p = n.s.) noch durch Drainage (16,7 ± 16,5/13,0 ± 9,0; p = n.s.) wesentlich beeinträchtigt, bei allen 3 Tumorpatienten jedoch verschlechtert (42,9 ± 15,7/17,5 ± 3,8). Eine vergleichbare Konstellation ergab sich bei der stimulierten C-Peptidsynthese [ngmin/ml] fur resezierte (90,5 ± 85,6/73,8 ± 48,9; p = n.s.) and drainierte (121,3 ± 67,5/98,0 ± 57,2; p = n.s.) CP-bzw. für resezierte Tumorpatienten (157,8 ± 66,9/125,1 ± 69,6). In der chirurgischen Behandlung der chronischen Pankreatitis führt eine Resektion nicht automatisch zum \-Zellfunktionsverlust. Die Parenchymerhaltung bei Gangdrainageoperationen hat in diesem Zusammenhang keinen nachweisbaren Vorteil. Die Verfahrenswahl wird deshalb individuell von der konkreten Indikation, der Organmorphologie und den erwünschten Langzeitergebnissen der Operationstechnik beeinflußt.
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Heise, J.W., Becker, H., Niederau, C. et al. Einfluß von Resektion oder Gangdrainage auf die glukosestimulierte β-Zellfunktion bei chronischer Pankreatitis. Langenbecks Arch Chir 379, 44–49 (1994). https://doi.org/10.1007/BF00206561
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DOI: https://doi.org/10.1007/BF00206561