术后胰酶替代治疗对初始全胰切除术患者脂肪消化吸收功能的意义。

IF 2.8 2区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Pancreatology Pub Date : 2025-02-01 DOI:10.1016/j.pan.2024.12.011

Ryuta Shintakuya , Kenichiro Uemura , Tatsuaki Sumiyoshi , Kenjiro Okada , Kenta Baba , Takumi Harada , Yasutaka Ishii , Shiro Oka , Koji Arihiro , Yoshiaki Murakami , Shinya Takahashi

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引用次数: 0

摘要

目的：评价胰酶替代治疗对首次全胰切除术患者脂肪消化吸收的影响。方法：回顾性收集2012年至2020年在我科接受首次全胰腺切除术的患者的数据。评估初始全胰切除术前后的脂肪消化、吸收功能、血清营养指标、HbA1c水平和肝脂肪变性。比较初始全胰切除术和胰十二指肠切除术患者术前和术后1年这些参数的变化率。患者接受13c标记的混合甘油三酯呼吸试验来评估脂肪消化和吸收功能。使用计算机断层扫描评估肝脂肪变性。结果：17例连续接受初始全胰腺切除术的患者中，12例为男性，中位年龄为70岁。17例患者术后恢复进食时均给予胰酶1800 mg。术前和术后1年的中位剂量（%）为13C / 7h(%)，血清营养指标，HbA1c水平和肝脏计算机断层扫描结果无显著差异。2例患者术后出现非酒精性脂肪肝，无严重疾病进展。总共有48例接受胰十二指肠切除术的患者符合条件。在初始全胰切除术组和胰十二指肠切除术组之间，剂量13C / 7 h（%）、血清营养指标、HbA1c水平和术后1年肝脏计算机断层扫描结果的中位变化显示无显著差异。结论：初始全胰切除术后大剂量胰酶替代治疗可维持脂肪消化吸收功能和营养状况，预防肝脂肪变性。

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Significance of administering postoperative pancreatic enzyme replacement therapy for fat digestion and absorption functions in patients who underwent initial total pancreatectomy

Objectives

To evaluate the effects of postoperative pancreatic enzyme replacement therapy on fat digestion and absorption in patients following initial total pancreatectomy.

Methods

Data were retrospectively collected from patients who underwent initial total pancreatectomy at our department between 2012 and 2020. Fat digestion, absorption functions, serum nutritional markers, HbA1c levels, and hepatic steatosis before and after the initial total pancreatectomy were evaluated. The rate of change in these parameters pre- and 1-year postoperatively were compared between patients with initial total pancreatectomy and pancreaticoduodenectomy. Patients underwent the ¹³C-labeled mixed triglyceride breath test to evaluate fat digestion and absorption functions. Hepatic steatosis was assessed using computed tomography.

Results

Of 17 consecutive patients who underwent initial total pancreatectomy, 12 were men, and the median age was 70 years. All 17 patients received 1800 mg pancrelipase when food intake was resumed after surgery. The pre- and 1-year postoperative median % dose ¹³C cum 7 h (%), serum nutritional markers, HbA1c levels, and liver computed tomography findings did not differ significantly. Two patients had nonalcoholic fatty liver disease after surgery, without serious disease progression. In total, 48 patients who underwent pancreaticoduodenectomy were found eligible. The median change in % dose ¹³C cum 7 h (%), serum nutritional markers, HbA1c levels, and liver computed tomography findings pre and 1-year postoperatively showed no significant differences between the initial total pancreatectomy and pancreaticoduodenectomy groups.

Conclusions

High-dose pancreatic enzyme replacement therapy after initial total pancreatectomy might maintain fat digestion and absorption functions and nutritional status and prevent hepatic steatosis.

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来源期刊

Pancreatology 医学-胃肠肝病学

CiteScore

7.20

自引率

5.60%

发文量

194

审稿时长

44 days

期刊介绍： Pancreatology is the official journal of the International Association of Pancreatology (IAP), the European Pancreatic Club (EPC) and several national societies and study groups around the world. Dedicated to the understanding and treatment of exocrine as well as endocrine pancreatic disease, this multidisciplinary periodical publishes original basic, translational and clinical pancreatic research from a range of fields including gastroenterology, oncology, surgery, pharmacology, cellular and molecular biology as well as endocrinology, immunology and epidemiology. Readers can expect to gain new insights into pancreatic physiology and into the pathogenesis, diagnosis, therapeutic approaches and prognosis of pancreatic diseases. The journal features original articles, case reports, consensus guidelines and topical, cutting edge reviews, thus representing a source of valuable, novel information for clinical and basic researchers alike.