Abstract：
OBJECTIVE: Some researchers are concerned that the performance of pancreatic resection in cases of low malignancy with distal localization will increase, resulting in the occurrence or worsening of post-operative glucose intolerance. Herein, we retrospectively investigated the relationship between the pancreatic resection ratio and post-operative glucose intolerance in distal pancreatectomy (DP).
METHODS: Total 135 patients who underwent DP at our hospital and were followed up for > 12 months between January 2013 and December 2022 were included. Of these, 52 patients were included, excluding those with pre-operative diabetes and those who underwent pancreatectomy using other than a stapling device. The pancreatic resection ratio (%) was measured using pancreatic volumetry by manually tracing the pancreatic area on computed tomography images obtained before and after surgery and the relationship with post-operative glucose intolerance was investigated.
RESULTS: Among the 52 patients, 13 (25.0%) showed post-operative worsening of glucose tolerance (impaired glucose tolerance [IGT] group). The pancreatic resection ratios were 51.1% and 34.8% in the IGT (13 patients) and non-IGT groups (39 patients), respectively (p = 0.0027). The cut-off value for the IGT group was 46.5%. The resection site was divided into two groups as follows. One group was resected near the portal vein (portal group) and the other group was resected more caudally (caudal group). Mean pancreatic resection ratios were 46.5% and 28.5% in cases of resection of the portal group (30 patients) and caudal group (22 patients), respectively (p < 0.0001). The thickness of the pancreas at the resection site was 13.1 mm in the portal group and 17.7 mm in the caudal group (p < 0.0001) and the incidence of pancreatic fistula was 6.7% and 9.1%, respectively (p = 0.7472). The incidence of post-operative glucose intolerance was 40.0% (12/30) in the portal group and 4.5% (1/22) in the caudal group (p = 0.0016).
CONCLUSIONS: In cases of low-grade tumors and benign disease, pancreatic resection with preservation of the remaining pancreatic volume should be considered whenever possible.
METHODS: Total 135 patients who underwent DP at our hospital and were followed up for > 12 months between January 2013 and December 2022 were included. Of these, 52 patients were included, excluding those with pre-operative diabetes and those who underwent pancreatectomy using other than a stapling device. The pancreatic resection ratio (%) was measured using pancreatic volumetry by manually tracing the pancreatic area on computed tomography images obtained before and after surgery and the relationship with post-operative glucose intolerance was investigated.
RESULTS: Among the 52 patients, 13 (25.0%) showed post-operative worsening of glucose tolerance (impaired glucose tolerance [IGT] group). The pancreatic resection ratios were 51.1% and 34.8% in the IGT (13 patients) and non-IGT groups (39 patients), respectively (p = 0.0027). The cut-off value for the IGT group was 46.5%. The resection site was divided into two groups as follows. One group was resected near the portal vein (portal group) and the other group was resected more caudally (caudal group). Mean pancreatic resection ratios were 46.5% and 28.5% in cases of resection of the portal group (30 patients) and caudal group (22 patients), respectively (p < 0.0001). The thickness of the pancreas at the resection site was 13.1 mm in the portal group and 17.7 mm in the caudal group (p < 0.0001) and the incidence of pancreatic fistula was 6.7% and 9.1%, respectively (p = 0.7472). The incidence of post-operative glucose intolerance was 40.0% (12/30) in the portal group and 4.5% (1/22) in the caudal group (p = 0.0016).
CONCLUSIONS: In cases of low-grade tumors and benign disease, pancreatic resection with preservation of the remaining pancreatic volume should be considered whenever possible.
摘要：
目的：一些研究人员担心，在远端定位的低恶性病例中，胰腺切除术的性能会增加，导致术后葡萄糖不耐受的发生或恶化。在这里，我们回顾性研究了胰体远端切除术(DP)中胰腺切除率与术后葡萄糖耐受不良之间的关系.
方法：纳入2013年1月至2022年12月在我院接受DP治疗并随访12个月以上的患者共135例。其中,包括52例患者，不包括那些术前糖尿病患者和那些使用除吻合装置以外的其他方法进行胰腺切除术的患者。通过在手术前后获得的计算机断层扫描图像上手动追踪胰腺面积，使用胰腺容积法测量胰腺切除率（％），并研究了与术后葡萄糖耐受不良的关系。
结果：在52例患者中，13（25.0％）显示术后糖耐量恶化（糖耐量受损[IGT]组）。IGT组(13例)和非IGT组(39例)的胰腺切除率分别为51.1%和34.8%,分别(p=0.0027)。IGT组的临界值为46.5%。切除部位分为以下两组。一组切除门静脉附近（门静脉组），另一组切除更多的尾端（尾端组）。门静脉组（30例）和尾管组（22例）的平均胰腺切除率为46.5％和28.5％，分别(p<0.0001)。门静脉组切除部位胰腺厚度为13.1mm,尾管组为17.7mm(p<0.0001),胰瘘发生率分别为6.7%和9.1%,分别(p=0.7472)。术后葡萄糖不耐受发生率在门静脉组为40.0％（12/30），在尾管组为4.5％（1/22）（p=0.0016）。
结论：在低度肿瘤和良性疾病的病例中，应尽可能考虑保留剩余胰腺体积的胰腺切除术.
方法：纳入2013年1月至2022年12月在我院接受DP治疗并随访12个月以上的患者共135例。其中,包括52例患者，不包括那些术前糖尿病患者和那些使用除吻合装置以外的其他方法进行胰腺切除术的患者。通过在手术前后获得的计算机断层扫描图像上手动追踪胰腺面积，使用胰腺容积法测量胰腺切除率（％），并研究了与术后葡萄糖耐受不良的关系。
结果：在52例患者中，13（25.0％）显示术后糖耐量恶化（糖耐量受损[IGT]组）。IGT组(13例)和非IGT组(39例)的胰腺切除率分别为51.1%和34.8%,分别(p=0.0027)。IGT组的临界值为46.5%。切除部位分为以下两组。一组切除门静脉附近（门静脉组），另一组切除更多的尾端（尾端组）。门静脉组（30例）和尾管组（22例）的平均胰腺切除率为46.5％和28.5％，分别(p<0.0001)。门静脉组切除部位胰腺厚度为13.1mm,尾管组为17.7mm(p<0.0001),胰瘘发生率分别为6.7%和9.1%,分别(p=0.7472)。术后葡萄糖不耐受发生率在门静脉组为40.0％（12/30），在尾管组为4.5％（1/22）（p=0.0016）。
结论：在低度肿瘤和良性疾病的病例中，应尽可能考虑保留剩余胰腺体积的胰腺切除术.
