中国实用外科杂志

中国实用外科杂志

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不同治疗术式对胰腺肿瘤病人糖代谢影响的前瞻性研究

陈    涛，金    钢，胡先贵，邵    卓，马洪运   

  1. 第二军医大学附属长海医院胰腺外科，上海200433
  • 发布日期:2011-12-29

  • Published:2011-12-29

摘要：

目的    研究胰腺肿瘤不同手术方式对病人糖代谢内环境稳态和胰岛素分泌的影响。方法    对第二军医大学附属长海医院胰腺外科2009-2010年手术治疗的120例胰腺肿瘤病人进行前瞻性研究，其中胰腺癌76例，胰腺良性肿瘤44例。64例行胰十二指肠切除术，56例胰体尾切除术。全部病人术前及术后第1、3、5、7、30天测定血浆空腹血糖、胰岛素、C-肽及糖化血红蛋白浓度。结果    胰腺部分切除导致了病人胰岛素释放的减少，无论是胰十二指肠切除术还是胰体尾切除术，病人术后基础胰岛素分泌水平较术前降低了40%左右（P<0.05）。不过，行胰十二指肠切除术的胰腺癌病人术后空腹血糖水平得到了明显改善，特别是胰腺癌合并糖尿病病人更加显著；而行胰体尾切除的良性胰腺肿瘤病人术后空腹血糖明显恶化（P<0.05）。结论    不同术式对胰腺肿瘤病人糖代谢呈现不同的影响，胰十二指肠切除术可以改善胰腺癌病人血糖水平，特别是胰腺癌合并糖尿病病人更加明显。

关键词: 胰腺肿瘤, 胰十二指肠切除术, 远端胰腺切除术, 糖代谢

Abstract:

Prospective study on glycometabolic effects after varied surgical treatments of pancreatic neoplasm        CHEN Tao, JIN Gang, HU Xiangui, et al. Department of Pancreatic Surgery, Changhai Hospital Affiliated to the Second Military Medical University, Shanghai 200433, China
Corresponding author: JIN Gang, E-mail: jingang@sohu.com
Abstract    Objective    To examine the effects of varied surgical treatments on glucose homeostasis and insulin secretion. Methods    Prospective study on 120 patients from January 2009 to November 2010 was done, including 76 patients(63.3%) with pancreatic cancer and 44 patients(36.7%) with benign pancreatic tumors. 64 patients were underwent pancreaticoduodenectomy and 56 patients were underwent distal pancreatectomy. We examined the preoperative and postoperative (the 1st, 3rd, 5th, 7th days and one month after operation) plasma concentrations of fasting glucose, insulin, c-peptide and glycated hemoglobin of all 120 patients. Results    Partial pancreatectomy leads to a reduction in insulin secretion approximately by 40% in both pancreatic cancer and benign pancreatic tumor patients (P<0.05).  However, pancreaticoduodenectomy reduces fasting glucose concentration in patients with pancreatic head cancer, especially in patients with diabetes mellitus, whereas distal pancreatectomy led to deterioration in fasting blood glucose in patients with benign pancreatic body-tail tumor (P<0.05). Conclusion    Glycometabolic effects after varied surgical treatments of pancreatic tumors are different. Pancreaticoduodenectomy can ameliorate glycometabolism in patients with pancreatic cancer, especially in patients with pancreatic cancer and diabetes mellitus.

Key words: pancreatic tumor, pancreaticoduodenectomy, distal pancreatectomy, glycometabolism