Abstract：
BACKGROUND: Patients undergoing pancreatic surgery are at risk of pancreatic exocrine insufficiency (PEI) and needing pancreatic enzyme replacement therapy (PERT).
METHODS: This study included 254 patients undergoing pancreatic surgery for oncologic indications. A13C mixed triglyceride breath test was performed immediately preoperative and postoperative. This test analyzes the pancreatic remnant lipase activity measuring 13CO2 in breath samples after a test meal with 1.3-distearyl-(13C-Carboxyl)octanol-glycerol. Cumulative percent dose recovery after 6 h of less than 23% confirms PEI. In addition, PEI was compared between pathology subgroups.
RESULTS: In 197 patients undergoing pancreaticoduodenectomy, cPDR-6h decreased significantly from a median of 32.84% before to 15.80% after surgery (p < 0.0001). This decrease in exocrine function was significant in all pathology subgroups except in pancreatic neuroendocrine tumors. Exocrine function decreased most in pancreatic ductal adenocarcinoma (PDAC). In addition, the percentage of patients needing PERT because of PEI increased from 25.9% to 68.0% postoperative (p < 0.001). Overall, patients with an MPD diameter of more than 3 mm had a higher risk of developing postoperative PEI: 62.7% compared to 37.3% (p = 0.009), OR = 3.11. In contrast, the majority of the 57 patients undergoing a distal pancreatectomy did not experience any significant change in exocrine function.
CONCLUSIONS: The vast majority of patients undergoing pancreaticoduodenectomy for oncologic indications experience a significant drop in exocrine function, are at high risk of developing pancreatic exocrine insufficiency and consequently need to be treated with pancreatic enzyme replacement therapy. Therefore, systematic screening for pancreatic exocrine insufficiency is needed after pancreaticoduodenectomy.
METHODS: This study included 254 patients undergoing pancreatic surgery for oncologic indications. A13C mixed triglyceride breath test was performed immediately preoperative and postoperative. This test analyzes the pancreatic remnant lipase activity measuring 13CO2 in breath samples after a test meal with 1.3-distearyl-(13C-Carboxyl)octanol-glycerol. Cumulative percent dose recovery after 6 h of less than 23% confirms PEI. In addition, PEI was compared between pathology subgroups.
RESULTS: In 197 patients undergoing pancreaticoduodenectomy, cPDR-6h decreased significantly from a median of 32.84% before to 15.80% after surgery (p < 0.0001). This decrease in exocrine function was significant in all pathology subgroups except in pancreatic neuroendocrine tumors. Exocrine function decreased most in pancreatic ductal adenocarcinoma (PDAC). In addition, the percentage of patients needing PERT because of PEI increased from 25.9% to 68.0% postoperative (p < 0.001). Overall, patients with an MPD diameter of more than 3 mm had a higher risk of developing postoperative PEI: 62.7% compared to 37.3% (p = 0.009), OR = 3.11. In contrast, the majority of the 57 patients undergoing a distal pancreatectomy did not experience any significant change in exocrine function.
CONCLUSIONS: The vast majority of patients undergoing pancreaticoduodenectomy for oncologic indications experience a significant drop in exocrine function, are at high risk of developing pancreatic exocrine insufficiency and consequently need to be treated with pancreatic enzyme replacement therapy. Therefore, systematic screening for pancreatic exocrine insufficiency is needed after pancreaticoduodenectomy.
摘要：
背景：接受胰腺手术的患者存在胰腺外分泌功能不全（PEI）和需要胰酶替代疗法（PERT）的风险。
方法：本研究包括254例因肿瘤适应症而接受胰腺手术的患者。术前、术后立即进行A13C混合甘油三酯呼气试验。该测试分析了在具有1.3-二硬脂酰-(13C-羧基)辛醇-甘油的测试餐后呼吸样品中测量13CO2的胰腺残余脂肪酶活性。6小时后小于23%的累积剂量恢复百分比证实了PEI。此外,在病理亚组之间比较PEI。
结果：在197例接受胰十二指肠切除术的患者中，cPDR-6h从手术前的中位数32.84％下降到手术后的15.80％（p<0.0001）。除胰腺神经内分泌肿瘤外，在所有病理亚组中，外分泌功能的这种降低都是显着的。胰腺导管腺癌（PDAC）的外分泌功能下降最多。此外,术后因PEI而需要PERT的患者比例从25.9%增加到68.0%(p<0.001).总的来说,MPD直径大于3mm的患者发生术后PEI的风险更高：62.7％，而37.3％（p=0.009），OR=3.11。相比之下,在接受远端胰腺切除术的57例患者中,大多数患者的外分泌功能没有发生任何显著变化.
结论：绝大多数因肿瘤适应症而接受胰十二指肠切除术的患者外分泌功能显著下降，有发生胰腺外分泌功能不全的高风险，因此需要用胰腺酶替代疗法治疗。因此,胰十二指肠切除术后需要进行胰腺外分泌功能不全的系统筛查.
方法：本研究包括254例因肿瘤适应症而接受胰腺手术的患者。术前、术后立即进行A13C混合甘油三酯呼气试验。该测试分析了在具有1.3-二硬脂酰-(13C-羧基)辛醇-甘油的测试餐后呼吸样品中测量13CO2的胰腺残余脂肪酶活性。6小时后小于23%的累积剂量恢复百分比证实了PEI。此外,在病理亚组之间比较PEI。
结果：在197例接受胰十二指肠切除术的患者中，cPDR-6h从手术前的中位数32.84％下降到手术后的15.80％（p<0.0001）。除胰腺神经内分泌肿瘤外，在所有病理亚组中，外分泌功能的这种降低都是显着的。胰腺导管腺癌（PDAC）的外分泌功能下降最多。此外,术后因PEI而需要PERT的患者比例从25.9%增加到68.0%(p<0.001).总的来说,MPD直径大于3mm的患者发生术后PEI的风险更高：62.7％，而37.3％（p=0.009），OR=3.11。相比之下,在接受远端胰腺切除术的57例患者中,大多数患者的外分泌功能没有发生任何显著变化.
结论：绝大多数因肿瘤适应症而接受胰十二指肠切除术的患者外分泌功能显著下降，有发生胰腺外分泌功能不全的高风险，因此需要用胰腺酶替代疗法治疗。因此,胰十二指肠切除术后需要进行胰腺外分泌功能不全的系统筛查.
